NPI Code Detail JSON Logo

1457712309 NPI number — DERDERYAN MEDICAL GROUP INC.

NPI Number: 1457712309
Health Care Provider/Practitioner: DERDERYAN MEDICAL GROUP INC.

Information about “1457712309” NPI (DERDERYAN MEDICAL GROUP INC.) exists in 1457712309 in HTML format HTML  |  1457712309 in plain Text format TXT  |  1457712309 in PDF (Portable Document Format) PDF  |  1457712309 in an XML format XML  formats.

NPI Number : 1457712309 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457712309",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DERDERYAN MEDICAL GROUP INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4955 VAN NUYS BLVD STE 308",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SHERMAN OAKS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91403-1811",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4955 VAN NUYS BLVD STE 308",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHERMAN OAKS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91403-1811",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "646-552-1547",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/18/2016",
    "LastUpdateDate": "02/07/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DERDERYAN",
    "AuthorizedOfficialFirstName": "EDMOND",
    "AuthorizedOfficialMiddleName": "VARUZHAN",
    "AuthorizedOfficialTitle": "PRESIDENT/OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D",
    "AuthorizedOfficialTelephoneNumber": "646-552-1547",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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