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General NPI Number Information
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NPI Number | 1457712309
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Entity Type | Organization
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Legal Business Name | DERDERYAN MEDICAL GROUP INC.
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 02/07/2021
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Provider Practice Location Address
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Address Line | 4955 VAN NUYS BLVD STE 308
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1811
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Country | US
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Telephone | 646-552-1547
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Fax |
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Provider Business Mailing Address
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Address Line | 4955 VAN NUYS BLVD STE 308
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1811
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. EDMOND VARUZHAN DERDERYAN
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Credential | M.D
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Telephone | 646-552-1547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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