Provider Demographics
NPI:1689668188
Name:TCHEJEYAN, GREGORY H (MD, INC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:H
Last Name:TCHEJEYAN
Suffix:
Gender:M
Credentials:MD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 LOMBARD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8208
Mailing Address - Country:US
Mailing Address - Phone:805-495-3687
Mailing Address - Fax:805-494-1828
Practice Address - Street 1:250 LOMBARD ST STE 1
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8208
Practice Address - Country:US
Practice Address - Phone:805-495-3687
Practice Address - Fax:805-494-1828
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55364174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376835330OtherNPI TYPE II
CA1376835330OtherNPI TYPE II
CA010710097OtherTAX ID NUMBER
CAA55364Medicare ID - Type Unspecified
CA6500680001Medicare NSC