Provider Demographics
NPI:1619950342
Name:BOYADJIAN, SHOVEK X
Entity Type:Individual
Prefix:MRS
First Name:SHOVEK
Middle Name:
Last Name:BOYADJIAN
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:#205
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-781-2706
Mailing Address - Fax:818-781-2703
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:#205
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-781-2706
Practice Address - Fax:818-781-2703
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16234Medicare UPIN