Provider Demographics
NPI:1437384914
Name:YERVAND DARVEN SET-AGAYAN DO PC
Entity Type:Organization
Organization Name:YERVAND DARVEN SET-AGAYAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YERVAND
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SET-AGAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-383-6789
Mailing Address - Street 1:800 S CENTRAL AVE
Mailing Address - Street 2:UNIT # 306
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4370
Mailing Address - Country:US
Mailing Address - Phone:818-383-6789
Mailing Address - Fax:818-242-4022
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:UNIT # 306
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-383-6789
Practice Address - Fax:818-242-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9932OtherLICENCE NUMBER