Provider Demographics
NPI:1134239353
Name:BAGHOUMIAN, HAMLET (MD)
Entity type:Individual
Prefix:
First Name:HAMLET
Middle Name:
Last Name:BAGHOUMIAN
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 1:435 ARDEN AVE
Mailing Address - Street 2:310
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1130
Mailing Address - Country:US
Mailing Address - Phone:818-649-1847
Mailing Address - Fax:819-649-1848
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:310
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1130
Practice Address - Country:US
Practice Address - Phone:818-649-1847
Practice Address - Fax:819-649-1848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH44096Medicare UPIN
CAWA70293CMedicare ID - Type UnspecifiedPPIN