=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457943862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE HEALTH MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2021
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3630 E IMPERIAL HWY # 55B
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-722-1108
-----------------------------------------------------
Fax | 310-362-8957
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3630 E. IMPERIAL HWY 0055B
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-722-1108
-----------------------------------------------------
Fax | 310-362-8957
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/CO-OWNER
-----------------------------------------------------
Name | EDMOND VARUZHAN DERDERYAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-552-1547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------