Provider Demographics
NPI:1538168174
Name:HMAYAKYAN, SAMVEL (MD)
Entity type:Individual
Prefix:
First Name:SAMVEL
Middle Name:
Last Name:HMAYAKYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:HMAYAKYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1133 S CENTRAL AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2212
Mailing Address - Country:US
Mailing Address - Phone:818-244-0400
Mailing Address - Fax:818-244-2836
Practice Address - Street 1:1133 S CENTRAL AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2212
Practice Address - Country:US
Practice Address - Phone:818-244-0400
Practice Address - Fax:818-244-2836
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66625207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A666251Medicaid
CABH6824571OtherDEA
CAH22836Medicare UPIN
CA00A666251Medicaid