Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A66625 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A66625 | CA |
NPI | 1538168174 |
---|---|
Provider Name | Samvel Hmayakyan |
First Address | Glendale, CA 91204-2212 |
Second Address | Glendale, CA 91204-2212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 27/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A666251 | (05) | CA |
BH6824571 | DEA (01) | CA |
H22836 | (02) | CA |