Healthcare Provider Details

I. General information

NPI: 1922116664
Provider Name (Legal Business Name): RICHY AGAJANIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE STE 309
DOWNEY CA
90241-5018
US

IV. Provider business mailing address

18000 STUDEBAKER RD STE 800
CERRITOS CA
90703-2679
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-1201
  • Fax: 562-869-1281
Mailing address:
  • Phone: 562-735-3226
  • Fax: 562-869-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18467
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number45450
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6498490001
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA70830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: