Provider Demographics
NPI:1952053589
Name:SEMERDZHYAN, GEVORK
Entity Type:Individual
Prefix:
First Name:GEVORK
Middle Name:
Last Name:SEMERDZHYAN
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 1:36 MERLON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3905
Mailing Address - Country:US
Mailing Address - Phone:626-604-6484
Mailing Address - Fax:
Practice Address - Street 1:36 MERLON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3905
Practice Address - Country:US
Practice Address - Phone:626-604-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program