Healthcare Provider Details

I. General information

NPI: 1255277000
Provider Name (Legal Business Name): XCLUSIVE HEALTH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR STE 100
GLENDALE CA
91205-4437
US

IV. Provider business mailing address

801 S CHEVY CHASE DR STE 100
GLENDALE CA
91205-4437
US

V. Phone/Fax

Practice location:
  • Phone: 310-933-9779
  • Fax:
Mailing address:
  • Phone: 310-933-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GOHAR GEVORGYAN
Title or Position: CEO/OWNER
Credential: MD
Phone: 323-353-3708