Provider Demographics
NPI:1053618454
Name:GARNIK YEGYAN MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:GARNIK YEGYAN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GARNIK
Authorized Official - Middle Name:
Authorized Official - Last Name:YEGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-2212
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:#101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-247-2212
Mailing Address - Fax:818-247-0725
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:#101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-247-2212
Practice Address - Fax:818-247-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty