Healthcare Provider Details

I. General information

NPI: 1073748679
Provider Name (Legal Business Name): JOHN YERMIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 VAN NUYS
VAN NUYS CA
91405
US

IV. Provider business mailing address

7020 VAN NUYS BLVD
VAN NUYS CA
91405-3059
US

V. Phone/Fax

Practice location:
  • Phone: 818-780-7900
  • Fax: 818-994-9988
Mailing address:
  • Phone: 818-780-7900
  • Fax: 818-994-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA42042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: