Healthcare Provider Details

I. General information

NPI: 1528182565
Provider Name (Legal Business Name): YEPREMIAN MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E OLIVE AVE SUITE 750
BURBANK CA
91501-3316
US

IV. Provider business mailing address

500 E OLIVE AVE SUITE 750
BURBANK CA
91501-3316
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-1113
  • Fax: 818-848-1181
Mailing address:
  • Phone: 818-848-1113
  • Fax: 818-848-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA81317
License Number StateCA

VIII. Authorized Official

Name: DR. KELLY JOY YEPREMIAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 818-848-1113