Healthcare Provider Details

I. General information

NPI: 1154990646
Provider Name (Legal Business Name): STEPAN ESAGIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date: 04/06/2023
Reactivation Date: 10/27/2023

III. Provider practice location address

1515 HOLCOMBE BLVD
HOUSTON TX
77030-4000
US

IV. Provider business mailing address

1515 HOLCOMBE BLVD
HOUSTON TX
77030-4000
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5642
  • Fax: 877-632-6789
Mailing address:
  • Phone: 877-632-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: