Provider Demographics
NPI:1952516627
Name:LOS ANGELES HEMATOLOGY-ONCOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:LOS ANGELES HEMATOLOGY-ONCOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGDASARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-696-6994
Mailing Address - Street 1:1505 WILSON TER STE 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4074
Mailing Address - Country:US
Mailing Address - Phone:818-696-6994
Mailing Address - Fax:844-292-1565
Practice Address - Street 1:1505 WILSON TER STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4073
Practice Address - Country:US
Practice Address - Phone:323-910-4060
Practice Address - Fax:818-279-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0051272Medicaid
CAW11605BMedicare ID - Type UnspecifiedMEDICARE