Provider Demographics
NPI:1881708824
Name:GEVORGIAN, ARTIN (DPM)
Entity type:Individual
Prefix:DR
First Name:ARTIN
Middle Name:
Last Name:GEVORGIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W ALAMEDA AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4822
Mailing Address - Country:US
Mailing Address - Phone:818-841-8400
Mailing Address - Fax:818-841-8402
Practice Address - Street 1:2625 W ALAMEDA AVE STE 314
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4822
Practice Address - Country:US
Practice Address - Phone:818-841-8400
Practice Address - Fax:818-841-8402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4064213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40640Medicaid
CA000E40641Medicaid
CA000E40640Medicaid
CA000E40640Medicare ID - Type Unspecified