Provider Demographics
NPI:1649292715
Name:KEVIN G. GALSTYAN M.D., INC
Entity type:Organization
Organization Name:KEVIN G. GALSTYAN M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GALSTYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-502-4567
Mailing Address - Street 1:222 W EULALIA ST
Mailing Address - Street 2:211
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-502-4567
Mailing Address - Fax:818-502-4568
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:211
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-502-4567
Practice Address - Fax:818-502-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87868OtherCA MEDICAL LICENSE NUMBER