Healthcare Provider Details

I. General information

NPI: 1538740584
Provider Name (Legal Business Name): PHILLIP VARTANYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 SAND CANYON AVE
IRVINE CA
92618-3714
US

IV. Provider business mailing address

16250 SAND CANYON AVE
IRVINE CA
92618-3714
US

V. Phone/Fax

Practice location:
  • Phone: 818-426-6353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301514828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: