Provider Demographics
NPI:1538270749
Name:GAZARIAN, LEVON HAIK (MD)
Entity type:Individual
Prefix:DR
First Name:LEVON
Middle Name:HAIK
Last Name:GAZARIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:STE 203
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9273
Mailing Address - Country:US
Mailing Address - Phone:626-446-1190
Mailing Address - Fax:626-446-7637
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:STE 203
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9273
Practice Address - Country:US
Practice Address - Phone:626-446-1190
Practice Address - Fax:626-446-7637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA40804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A408040Medicaid
A40804OtherA40804
CA00A408040Medicaid