Provider Demographics
NPI:1689038424
Name:DERMENDJIAN, HAROUT (MD)
Entity Type:Individual
Prefix:
First Name:HAROUT
Middle Name:
Last Name:DERMENDJIAN
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 1:1731 W KENNETH RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1451
Mailing Address - Country:US
Mailing Address - Phone:323-791-8918
Mailing Address - Fax:
Practice Address - Street 1:28049 SMYTH DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4023
Practice Address - Country:US
Practice Address - Phone:661-705-9706
Practice Address - Fax:661-702-1701
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1510682085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology