Provider Demographics
NPI:1598398539
Name:EDUARD DUDUKGIAN M.D., A PROFESSIONAL CO
Entity Type:Organization
Organization Name:EDUARD DUDUKGIAN M.D., A PROFESSIONAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDUKGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-644-4904
Mailing Address - Street 1:1300 N VERMONT AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6088
Mailing Address - Country:US
Mailing Address - Phone:323-644-4904
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERMONT AVE STE 601
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6088
Practice Address - Country:US
Practice Address - Phone:323-644-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care