Provider Demographics
NPI:1255301040
Name:TASHJIAN, GEORGE KEVORK (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KEVORK
Last Name:TASHJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-265-2260
Mailing Address - Fax:818-265-2268
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-265-2260
Practice Address - Fax:818-265-2268
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81027208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA81027AMedicare PIN
CAI24674Medicare UPIN