Organization Active NPI

Krekor a Tomassian MD a Prof Corp

  • Geriatric Medicine (Family Medicine) Physician
  • Glendora, CA
National Provider Identifier
1700109519
Registry record updated Dec 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
KREKOR A TOMASSIAN MD A PROF CORP
Practice address
415 W Rout 66
201
Glendora, CA 91740
Phone
(626) 963-0900
Fax
(626) 963-9663
NPI assigned
Mar 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Krekor A Tomassian, MDNPI 1891807673
Title
Physician
Phone
(626) 963-0900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

415 W Rout 66
201
Glendora, CA 91740

Mailing address

415 W Rout 66
201
Glendora, CA 91740
Phone (626) 963-0900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110104000172 CA Part B Supplier - Clinic/Group Practice 9133317324 Receives reassigned benefits from 1 practitioner
Practice locations: Glendora, CA

National Provider Directory

National Provider Directory

Locations

415 W Route 66
Ste 201
Glendora, CA 91740
Phone (626) 963-0253

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292803200000",
    "number": "1700109519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 W ROUT 66",
            "address_2": "201",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "91740",
            "telephone_number": "626-963-0900",
            "fax_number": "626-963-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W ROUT 66",
            "address_2": "201",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "91740",
            "telephone_number": "626-963-0900",
            "fax_number": "626-963-9663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KREKOR A TOMASSIAN MD A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-08",
        "last_updated": "2010-12-20",
        "status": "A",
        "authorized_official_last_name": "TOMASSIAN",
        "authorized_official_first_name": "KREKOR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "626-963-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.