Provider Demographics
NPI:1770582967
Name:LAVIAN, DAVID (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LAVIAN
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:PO BOX 571286
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-1286
Mailing Address - Country:US
Mailing Address - Phone:818-782-4300
Mailing Address - Fax:818-782-6411
Practice Address - Street 1:14600 SHERMAN WAY
Practice Address - Street 2:STE 215
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2283
Practice Address - Country:US
Practice Address - Phone:818-782-4300
Practice Address - Fax:818-782-6411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A463700Medicaid
CA00A463700Medicaid
A63439Medicare UPIN