Provider Demographics
NPI:1750443438
Name:HAJIAN, HOVSEP
Entity Type:Individual
Prefix:MR
First Name:HOVSEP
Middle Name:
Last Name:HAJIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1006
Mailing Address - Country:US
Mailing Address - Phone:818-846-6315
Mailing Address - Fax:818-972-3979
Practice Address - Street 1:269 W ALAMEDA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2520
Practice Address - Country:US
Practice Address - Phone:818-846-6315
Practice Address - Fax:818-972-3979
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN00762F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00762FMedicaid