Healthcare Provider Details

I. General information

NPI: 1396684692
Provider Name (Legal Business Name): GYNECOLOGIC ONCOLOGY CARE, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S GLENDALE AVE STE 402
GLENDALE CA
91205-2866
US

IV. Provider business mailing address

1030 S GLENDALE AVE STE 402
GLENDALE CA
91205-2866
US

V. Phone/Fax

Practice location:
  • Phone: 818-230-6522
  • Fax: 818-230-6523
Mailing address:
  • Phone: 818-230-6522
  • Fax: 818-230-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAFFI CHAILIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-230-6522