Healthcare Provider Details

I. General information

NPI: 1205125804
Provider Name (Legal Business Name): VAHE MICHAEL AZARIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 07/29/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 W VERNON AVE
LOS ANGELES CA
90037-3038
US

IV. Provider business mailing address

985 W VERNON AVE
LOS ANGELES CA
90037-3038
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-6300
  • Fax: 323-234-0100
Mailing address:
  • Phone: 323-234-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA125140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: