Provider Demographics
NPI:1235271297
Name:MELIDONIAN, HOVANNES (MD)
Entity Type:Individual
Prefix:DR
First Name:HOVANNES
Middle Name:
Last Name:MELIDONIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W COLORADO ST
Mailing Address - Street 2:#1
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1663
Mailing Address - Country:US
Mailing Address - Phone:818-548-2618
Mailing Address - Fax:818-548-2618
Practice Address - Street 1:318 W COLORADO ST
Practice Address - Street 2:#1
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1663
Practice Address - Country:US
Practice Address - Phone:818-548-2618
Practice Address - Fax:818-548-2618
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0071716Medicare UPIN