Provider Demographics
NPI: | 1669653077 |
---|---|
Name: | ARMEN HOVHANNISYAN MD GROUP INC |
Entity Type: | Organization |
Organization Name: | ARMEN HOVHANNISYAN MD GROUP INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DOCTOR MD |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ARMEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOVHANNISYAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 310-342-7000 |
Mailing Address - Street 1: | 5250 W CENTURY BLVD STE 333 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90045-5919 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-342-7000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5250 W CENTURY BLVD STE 333 |
Practice Address - Street 2: | |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90045-5919 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-342-7000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-11-14 |
Last Update Date: | 2009-12-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A99959 | 261Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |