Provider Demographics
NPI:1639230436
Name:YENIKOMSHIAN, AGHEG MIHRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AGHEG
Middle Name:MIHRAN
Last Name:YENIKOMSHIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 SAMARITAN DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4107
Mailing Address - Country:US
Mailing Address - Phone:408-356-7788
Mailing Address - Fax:
Practice Address - Street 1:2585 SAMARITAN DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4107
Practice Address - Country:US
Practice Address - Phone:408-356-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37996208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19614ZMedicare PIN
CAA36811Medicare UPIN