Provider Demographics
NPI:1255490793
Name:DAVIDIAN, HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:DAVIDIAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 SHOREHAM DR APT 1206
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2212
Mailing Address - Country:US
Mailing Address - Phone:424-313-8482
Mailing Address - Fax:
Practice Address - Street 1:8787 SHOREHAM DR APT 1206
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2212
Practice Address - Country:US
Practice Address - Phone:424-313-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502040Medicaid
CAWA50204CMedicare ID - Type UnspecifiedPPIN (MEDICARE IND. PIN)
F60284Medicare UPIN