Provider Demographics
NPI:1730570672
Name:BAGHOUMIAN MEDICAL INC.
Entity type:Organization
Organization Name:BAGHOUMIAN MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMLET
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHOUMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-469-4564
Mailing Address - Street 1:435 ARDEN AVE
Mailing Address - Street 2:310
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1130
Mailing Address - Country:US
Mailing Address - Phone:818-649-1847
Mailing Address - Fax:819-649-1848
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:310
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1130
Practice Address - Country:US
Practice Address - Phone:818-649-1847
Practice Address - Fax:819-649-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA70293CMedicare PIN