Healthcare Provider Details

I. General information

NPI: 1508593617
Provider Name (Legal Business Name): EDWARD SAMOURJIAN MEDICAL CORPORATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S GLENDALE AVE STE 503
GLENDALE CA
91205-2820
US

IV. Provider business mailing address

PO BOX 11719
BURBANK CA
91510-1719
US

V. Phone/Fax

Practice location:
  • Phone: 818-230-6522
  • Fax: 818-230-6523
Mailing address:
  • Phone: 818-504-7265
  • Fax: 818-504-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD SAMOURJIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-230-6522