Provider Demographics
NPI:1528182565
Name:YEPREMIAN MEDICAL CORP.
Entity Type:Organization
Organization Name:YEPREMIAN MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:YEPREMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-848-1113
Mailing Address - Street 1:500 E OLIVE AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-848-1113
Mailing Address - Fax:818-848-1181
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-848-1113
Practice Address - Fax:818-848-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81317261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17317Medicare PIN