Individual
GEVORG GHAZARYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 E BROADWAY STE 205, GLENDALE, CA 91205-2490
(818) 453-5192
(818) 452-0716
Mailing address
1100 E BROADWAY STE 205, GLENDALE, CA 91205-2490
(818) 453-5192
(818) 452-0716
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A104857
CA
208M00000X
Hospitalist Physician
Primary
A104857
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A104857
STATE LICENSE
CA
01
—
BLUE SHIELD
0A1048570
CA
Enumeration date
05/23/2007
Last updated
06/09/2024
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