Healthcare Provider Details

I. General information

NPI: 1104118389
Provider Name (Legal Business Name): JIVAN MELIKIAN M D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E CHEVY CHASE DR SUITE 206
GLENDALE CA
91206-4163
US

IV. Provider business mailing address

1530 E CHEVY CHASE DR SUITE 206
GLENDALE CA
91206-4163
US

V. Phone/Fax

Practice location:
  • Phone: 818-546-8644
  • Fax: 818-546-2494
Mailing address:
  • Phone: 818-546-8644
  • Fax: 818-546-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA45112
License Number StateCA

VIII. Authorized Official

Name: DR. JIVAN MELIKIAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 818-546-8644