Provider Demographics
NPI:1912227257
Name:JOHN P YERMIAN MD INC
Entity Type:Organization
Organization Name:JOHN P YERMIAN MD INC
Other - Org Name:PLAZA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:YERMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-780-7900
Mailing Address - Street 1:7020 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3059
Mailing Address - Country:US
Mailing Address - Phone:818-780-7900
Mailing Address - Fax:818-994-9988
Practice Address - Street 1:7020 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3059
Practice Address - Country:US
Practice Address - Phone:818-780-7900
Practice Address - Fax:818-994-9988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN P YERMIAN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-09
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42042261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10096014100245001OtherCCN