Provider Demographics
NPI:1548424294
Name:JEHDIAN, GARY (CPED)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:JEHDIAN
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:626-335-4615
Mailing Address - Fax:626-335-0966
Practice Address - Street 1:926 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4808
Practice Address - Country:US
Practice Address - Phone:626-335-4615
Practice Address - Fax:626-335-0966
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies