1831056738 NPI number — LOS ANGELES HEMATOLOGY ONCOLOGY MEDICAL GROUP

Table of content: (NPI 1831056738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831056738 NPI number — LOS ANGELES HEMATOLOGY ONCOLOGY MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES HEMATOLOGY ONCOLOGY MEDICAL GROUP
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:
1831056738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
541 W COLORADO ST STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91204-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-254-0046
Provider Business Mailing Address Fax Number:
323-488-9782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5525 ETIWANDA AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-317-4148
Provider Business Practice Location Address Fax Number:
866-246-1269
Provider Enumeration Date:
01/05/2026

Additional Information

Authorized Official

Authorized Official Last Name:
BAGDASARIAN
Authorized Official First Name:
BORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
DO
Authorized Official Telephone Number:
818-409-0105

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com