MEDICARE: EDWIN HARONIAN, M D. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A71385	CA

General Provider Information

NPI Number	:	1104007483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWIN HARONIAN, M D. INC.

Provider Business Mailing Address
First Line	:	5651 SEPULVEDA BLVD
Second Line	:	SUITE 201
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-2916
Country	:	US
Telephone Number	:	818-788-2400
Fax Number	:	818-788-2453

Provider Business Practice Location Address
First Line	:	5651 SEPULVEDA BLVD
Second Line	:	SUITE 201
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-2916
Country	:	US
Telephone Number	:	818-788-2400
Fax Number	:	818-788-2453

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWIN HARONIAN
Credential	:	M.D.
Telephone Number	:	818-788-2400

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	01/22/2024

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