Healthcare Provider Details

I. General information

NPI: 1114668456
Provider Name (Legal Business Name): LEVON GREGORIAN MD, DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEVON GREGORIAN MD, DO

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12669 ENCINITAS AVE
SYLMAR CA
91342-3635
US

IV. Provider business mailing address

12669 ENCINITAS AVE
SYLMAR CA
91342-3635
US

V. Phone/Fax

Practice location:
  • Phone: 800-700-8705
  • Fax:
Mailing address:
  • Phone: 800-700-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A24918
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO3973
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: