Provider Demographics
NPI:1356453724
Name:MATIAN MEDICAL CORP
Entity Type:Organization
Organization Name:MATIAN MEDICAL CORP
Other - Org Name:PRIME CARE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-995-7784
Mailing Address - Street 1:13425 VENTURA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3974
Mailing Address - Country:US
Mailing Address - Phone:818-995-7784
Mailing Address - Fax:818-995-7786
Practice Address - Street 1:13425 VENTURA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3974
Practice Address - Country:US
Practice Address - Phone:818-995-7784
Practice Address - Fax:818-995-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX78410OtherMEDI-CAL
CAW21970Medicare UPIN