Provider Demographics
NPI:1801069851
Name:TASHCHYAN SHOE COMPANY
Entity type:Organization
Organization Name:TASHCHYAN SHOE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:TASHCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-956-9130
Mailing Address - Street 1:556 RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1469
Mailing Address - Country:US
Mailing Address - Phone:818-956-9130
Mailing Address - Fax:818-240-2335
Practice Address - Street 1:556 RIVERDALE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1469
Practice Address - Country:US
Practice Address - Phone:818-956-9130
Practice Address - Fax:818-240-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4596620001Medicare NSC