Healthcare Provider Details

I. General information

NPI: 1750618237
Provider Name (Legal Business Name): PETER H ASHJIAN MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S JACKSON ST STE 109
GLENDALE CA
91205-1594
US

IV. Provider business mailing address

240 S JACKSON ST STE 109
GLENDALE CA
91205-1594
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-9611
  • Fax: 818-302-1699
Mailing address:
  • Phone: 818-241-9611
  • Fax: 818-302-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER HENRY ASHJIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-806-0432