1649292715 NPI number — KEVIN G. GALSTYAN M.D., INC

Table of content: (NPI 1649292715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649292715 NPI number — KEVIN G. GALSTYAN M.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEVIN G. GALSTYAN M.D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649292715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W EULALIA ST
Provider Second Line Business Mailing Address:
211
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91204-2849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-502-4567
Provider Business Mailing Address Fax Number:
818-502-4568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W EULALIA ST
Provider Second Line Business Practice Location Address:
211
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-502-4567
Provider Business Practice Location Address Fax Number:
818-502-4568
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALSTYAN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
GARY
Authorized Official Title or Position:
OWNER/M.D.
Authorized Official Telephone Number:
818-502-4567

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A87868 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A87868 . This is a "CA MEDICAL LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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