Provider Demographics
NPI:1770726754
Name:DAVID BOSTANJIAN MD INC
Entity type:Organization
Organization Name:DAVID BOSTANJIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTANJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-500-8466
Mailing Address - Street 1:410 ARDEN AVE
Mailing Address - Street 2:100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1127
Mailing Address - Country:US
Mailing Address - Phone:818-500-8466
Mailing Address - Fax:818-500-9562
Practice Address - Street 1:410 ARDEN AVE
Practice Address - Street 2:100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1127
Practice Address - Country:US
Practice Address - Phone:818-500-8466
Practice Address - Fax:818-500-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA97613Medicare PIN