Healthcare Provider Details

I. General information

NPI: 1427125509
Provider Name (Legal Business Name): TIGRAN IAN GEVORKIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E TULARE AVE
VISALIA CA
93292-3629
US

IV. Provider business mailing address

PO BOX 1487
LA CANADA FLINTRIDGE CA
91012-5487
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-4246
  • Fax:
Mailing address:
  • Phone: 818-472-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA74704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: