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Organization Active NPI

Family Practice of Glendale a Medical Corporation

Doing business as Family Medicine Center and Descanso Family Practice

  • Family Medicine Physician
  • Glendale, CA
National Provider Identifier
1801851043
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY PRACTICE OF GLENDALE A MEDICAL CORPORATION
Doing business as
Family Medicine Center and Descanso Family Practice
Practice address
801 S Chevy Chase Dr Ste 230
Glendale, CA 91205-4436
Phone
(818) 500-5586
Fax
(818) 500-5587
NPI assigned
Apr 19, 2006
Last updated
Apr 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Authorized official

Name
Dr. Sirvard Khanoyan, MD
Title
Program Director/ Officer/a.O.
Phone
(818) 445-7143

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X

Addresses

Primary practice location

801 S Chevy Chase Dr Ste 230
Glendale, CA 91205-4436

Mailing address

1125 E Broadway
Box 71
Glendale, CA 91205-1315
Phone (818) 500-5586

Other practice location 1

1818 Verdugo Blvd Ste 200
Glendale, CA 91208-1408
Phone (818) 790-1088

Other names 1

  • Family Medicine Center and Descanso Family Practice Doing business as

National Provider Directory

National Provider Directory

Locations

3144 Santa Anita Ave
El Monte, CA 91733
Phone (626) 401-4147

1125 E Broadway
Glendale, CA 91205
Phone (818) 240-8659

801 S Chevy Chase Dr
Ste 201
Glendale, CA 91205
Phone (818) 500-5535

801 S Chevy Chase Dr
Ste 230
Glendale, CA 91205
Phone (818) 500-5528

2515 W Pico Blvd
Los Angeles, CA 90006
Phone (213) 384-4555

2603 Via Campo
Montebello, CA 90640
Phone (323) 720-1144

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1801851043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 E BROADWAY",
            "address_2": "BOX 71",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051315",
            "telephone_number": "818-500-5586",
            "fax_number": "818-500-5583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S CHEVY CHASE DR STE 230",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912054436",
            "telephone_number": "818-500-5586",
            "fax_number": "818-500-5587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 Verdugo Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "912081408",
            "country_code": "US",
            "telephone_number": "818-790-1088",
            "fax_number": "818-790-1778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY PRACTICE OF GLENDALE A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "KHANOYAN",
        "authorized_official_first_name": "SIRVARD",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR/ OFFICER/A.O.",
        "authorized_official_telephone_number": "818-445-7143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Center and Descanso Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medicine Center and Descanso Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.