Individual
DMITRIY GEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1560 E CHEVY CHASE DR, GLENDALE, CA 91206-4197
(818) 246-5900
Mailing address
1560 E CHEVY CHASE DR, GLENDALE, CA 91206-4197
(818) 246-5900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A11253
CA
Other
Enumeration date
03/24/2011
Last updated
06/30/2011
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