Healthcare Provider Details

I. General information

NPI: 1538168174
Provider Name (Legal Business Name): SAMVEL HMAYAKYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAMUEL HMAYAKYAN M.D.

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/07/2023
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 S CENTRAL AVE UNIT 1
GLENDALE CA
91204-2212
US

IV. Provider business mailing address

1133 S CENTRAL AVE UNIT 1
GLENDALE CA
91204-2212
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-0400
  • Fax: 818-244-2836
Mailing address:
  • Phone: 818-244-0400
  • Fax: 818-244-2836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA66625
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA66625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: