MEDICARE: YEVGENYA SIMONYAN

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	207Q00000X	Family Medicine Physician	NP95033139	CA

General Provider Information

NPI Number	:	1114737798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENYA SIMONYAN

Provider Business Mailing Address
First Line	:	1630 SHADOW OAKS PL
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11240 MAGNOLIA BLVD STE 102
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3790
Country	:	US
Telephone Number	:	747-877-8184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/07/2025

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Directions to “ YEVGENYA SIMONYAN ” Practice Location

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