Healthcare Provider Details

I. General information

NPI: 1275911562
Provider Name (Legal Business Name): HARUT HOVSEPYAN M.D., M.P.H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 VERDUGO BLVD STE 260
GLENDALE CA
91208-1418
US

IV. Provider business mailing address

PO BOX 60259
LOS ANGELES CA
90060-0259
US

V. Phone/Fax

Practice location:
  • Phone: 818-476-4725
  • Fax: 818-476-4740
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-623-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA145584
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA145584
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA145584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: