Healthcare Provider Details

I. General information

NPI: 1912227257
Provider Name (Legal Business Name): JOHN P YERMIAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 VAN NUYS BLVD
VAN NUYS CA
91405-3059
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: JOHN YERMIAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 818-780-7900