Provider Demographics
NPI:1639320658
Name:MAISSIAN, GEVORK JOE (DO)
Entity Type:Individual
Prefix:
First Name:GEVORK
Middle Name:JOE
Last Name:MAISSIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1542
Mailing Address - Country:US
Mailing Address - Phone:818-243-1186
Mailing Address - Fax:818-243-3868
Practice Address - Street 1:1737 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1542
Practice Address - Country:US
Practice Address - Phone:818-243-1186
Practice Address - Fax:818-243-3868
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10524207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD728ZMedicare UPIN