Provider Demographics
NPI:1972679280
Name:ADVANCED HEALTH MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ADVANCED HEALTH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:GEVORKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-848-1555
Mailing Address - Street 1:401 S GLENOAKS BLVD
Mailing Address - Street 2:#101
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502
Mailing Address - Country:US
Mailing Address - Phone:818-848-1555
Mailing Address - Fax:818-842-9323
Practice Address - Street 1:401 S GLENOAKS BLVD
Practice Address - Street 2:#101
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502
Practice Address - Country:US
Practice Address - Phone:818-848-1555
Practice Address - Fax:818-842-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX55988Medicare UPIN
CAW15115Medicare PIN