Healthcare Provider Details

I. General information

NPI: 1891125753
Provider Name (Legal Business Name): DAVID GEVORKIAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAIN ST STE 200
LOS ANGELES CA
90012-4110
US

IV. Provider business mailing address

18527 BRASILIA DR
PORTER RANCH CA
91326-1913
US

V. Phone/Fax

Practice location:
  • Phone: 818-231-1401
  • Fax:
Mailing address:
  • Phone: 818-231-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: