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Organization
EDGEMONT MEDICAL CLINIC
Active
Organization
EDGEMONT MEDICAL CLINIC
Active
Other names
Edgemont Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MANUK CHULYAN PA (PRESIDENT)
(818) 504-7265
Entity
Organization
Contact information
Practice address
4864 SANTA MONICA BLVD, LOS ANGELES, CA 90029-2634
(323) 661-2700
(323) 661-2702
Mailing address
4864 SANTA MONICA BLVD, LOS ANGELES, CA 90029-2634
(323) 661-2700
(323) 661-2702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A10630
CA
208D00000X
General Practice Physician
20A10630
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043482060
NPI
CA
01
—
1881986826
NPI 1881986826
CA
Enumeration date
06/11/2014
Last updated
09/23/2026
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