Provider Demographics
NPI:1659510915
Name:YERVAND SET-AGAYAN DO INC
Entity Type:Organization
Organization Name:YERVAND SET-AGAYAN DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YERVAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SET-AGAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-507-8181
Mailing Address - Street 1:1330 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3349
Mailing Address - Country:US
Mailing Address - Phone:818-507-8181
Mailing Address - Fax:818-507-9431
Practice Address - Street 1:1330 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3349
Practice Address - Country:US
Practice Address - Phone:818-507-8181
Practice Address - Fax:818-507-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
20A9932OtherLICENSE NUMBER