Provider Demographics
NPI:1932684222
Name:DS MEDICAL CLINIC
Entity Type:Organization
Organization Name:DS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVHANNISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-229-8100
Mailing Address - Street 1:513 E LIME AVE UNIT 206
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2982
Mailing Address - Country:US
Mailing Address - Phone:323-229-8100
Mailing Address - Fax:
Practice Address - Street 1:513 E LIME AVE UNIT 206
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2982
Practice Address - Country:US
Practice Address - Phone:323-229-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center