=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912227257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN P YERMIAN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2010
-----------------------------------------------------
Last Update Date | 04/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7020 VAN NUYS BLVD
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-780-7900
-----------------------------------------------------
Fax | 818-994-9988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7020 VAN NUYS BLVD
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-780-7900
-----------------------------------------------------
Fax | 818-994-9988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | JOHN YERMIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-780-7900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | A42042
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------