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Organization
FAMILY PRACTICE OF GLENDALE A MEDICAL CORPORATION
Active
Organization
FAMILY PRACTICE OF GLENDALE A MEDICAL CORPORATION
Active
Other names
Family Medicine Center and Descanso Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIRVARD KHANOYAN MD (PROGRAM DIRECTOR/ OFFICER/A.O.)
(818) 445-7143
Entity
Organization
Contact information
Practice address
801 S CHEVY CHASE DR STE 230, GLENDALE, CA 91205-4436
(818) 500-5586
(818) 500-5587
Mailing address
1125 E BROADWAY, BOX 71, GLENDALE, CA 91205-1315
(818) 500-5586
(818) 500-5583
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0044710
—
CA
05
—
GR0044711
—
CA
Enumeration date
04/19/2006
Last updated
04/14/2020
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