Provider Demographics
NPI:1881234128
Name:MODERN NEPHROLOGY A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:MODERN NEPHROLOGY A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:VARTAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PAPAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-371-0338
Mailing Address - Street 1:16834 ARMSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18040 SHERMAN WAY STE 210
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4631
Practice Address - Country:US
Practice Address - Phone:818-371-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty