Provider Demographics
NPI:1013356344
Name:MINAEIAN, ARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ARTIN
Middle Name:
Last Name:MINAEIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 E CHEVY CHASE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4056
Mailing Address - Country:US
Mailing Address - Phone:818-265-2245
Mailing Address - Fax:877-575-9782
Practice Address - Street 1:1451 E CHEVY CHASE DR STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4056
Practice Address - Country:US
Practice Address - Phone:818-265-2245
Practice Address - Fax:877-575-9782
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2568012084N0400X
NY2745132084N0400X, 2084V0102X
CAA1358492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013356344Medicaid