Healthcare Provider Details

I. General information

NPI: 1437784360
Provider Name (Legal Business Name): YORK FAMILY MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5417 YORK BLVD
LOS ANGELES CA
90042-2401
US

IV. Provider business mailing address

5417 YORK BLVD
LOS ANGELES CA
90042-2401
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-2811
  • Fax: 323-254-1788
Mailing address:
  • Phone: 323-254-2811
  • Fax: 323-254-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AYUNA PANOSSIAN
Title or Position: OWNER
Credential: MD
Phone: 323-254-2811