=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366800443
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARON YEGIAIAN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2016
-----------------------------------------------------
Last Update Date | 01/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 139 S LOS ROBLES AVE UNIT B020
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-626-7670
-----------------------------------------------------
Fax | 626-818-4155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 E CEDAR AVE UNIT 103
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91501-3423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-626-7670
-----------------------------------------------------
Fax | 626-818-4155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHARON YEGIAIAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 626-626-7670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | A117162
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------