MEDICARE: YEPREMIAN MEDICAL CORP.

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	261QH0100X	Health Service Clinic/Center	A81317	CA

General Provider Information

NPI Number	:	1528182565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YEPREMIAN MEDICAL CORP.

Provider Business Mailing Address
First Line	:	500 E OLIVE AVE
Second Line	:	SUITE 750
City	:	BURBANK
State	:	CA
Zip	:	91501-3316
Country	:	US
Telephone Number	:	818-848-1113
Fax Number	:	818-848-1181

Provider Business Practice Location Address
First Line	:	500 E OLIVE AVE
Second Line	:	SUITE 750
City	:	BURBANK
State	:	CA
Zip	:	91501-3316
Country	:	US
Telephone Number	:	818-848-1113
Fax Number	:	818-848-1181

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. KELLY JOY YEPREMIAN
Credential	:	M.D.
Telephone Number	:	818-848-1113

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	02/14/2008

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