Provider Demographics
NPI:1720971195
Name:SVN MEDICAL GROUP
Entity type:Organization
Organization Name:SVN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-425-3074
Mailing Address - Street 1:17514 VENTURA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3896
Mailing Address - Country:US
Mailing Address - Phone:818-390-1987
Mailing Address - Fax:
Practice Address - Street 1:17514 VENTURA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3896
Practice Address - Country:US
Practice Address - Phone:818-390-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service