Provider Demographics
NPI:1396767471
Name:GALSTYAN, KEVIN GARY (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GARY
Last Name:GALSTYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1500 S. CENTRAL AVENUE
Mailing Address - Street 2:200
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-637-7618
Mailing Address - Fax:818-637-7616
Practice Address - Street 1:1500 S. CENTRAL AVENUE
Practice Address - Street 2:200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-637-7618
Practice Address - Fax:818-637-7616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA87868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87868OtherCA MEDICAL LICENSE NUMBER