Healthcare Provider Details

I. General information

NPI: 1891561676
Provider Name (Legal Business Name): LOS ANGELES HEMATOLOGY-ONCOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE 310
PASADENA CA
91105-4000
US

IV. Provider business mailing address

541 W COLORADO ST STE 320
GLENDALE CA
91204-3646
US

V. Phone/Fax

Practice location:
  • Phone: 323-910-4060
  • Fax: 818-279-0818
Mailing address:
  • Phone: 818-696-6994
  • Fax: 818-279-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: BORIS BAGDASARIAN
Title or Position: PARTNER
Credential: DO
Phone: 818-696-6994