NPIMap

Organization Active NPI

Vachik Shahnazarian MD Inc

  • Primary Care Clinic/Center
  • Glendale, CA
National Provider Identifier
1972799179
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A84308 Issued in CA
Legal business name
VACHIK SHAHNAZARIAN MD INC
Practice address
1030 S Glendale Ave
Suite 304
Glendale, CA 91205-5612
Phone
(818) 291-4041
NPI assigned
Sep 20, 2007
Last updated
Sep 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

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

Authorized official

Name
Dr. Vachik ShahnazarianNPI 1447396809
Title
President
Phone
(818) 291-4041

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
Primary Care Clinic/Center 261QP2300X A84308 CA Primary

Addresses

Primary practice location

1030 S Glendale Ave
Suite 304
Glendale, CA 91205-5612

Mailing address

1030 S Glendale Ave
Suite 304
Glendale, CA 91205-5612

Other identifiers 1

IdentifierTypeStateIssuer
00A843080MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121121000446 CA Part B Supplier - Clinic/Group Practice 7517118565 Receives reassigned benefits from 1 practitioner
Practice locations: Glendale, CA

National Provider Directory

National Provider Directory

Locations

1030 S Glendale Ave
Ste 304
Glendale, CA 91205
Phone (818) 291-4041

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1972799179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 S GLENDALE AVE",
            "address_2": "SUITE 304",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912055612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 S GLENDALE AVE",
            "address_2": "SUITE 304",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912055612",
            "telephone_number": "818-291-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VACHIK SHAHNAZARIAN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "SHAHNAZARIAN",
        "authorized_official_first_name": "VACHIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-291-4041",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A84308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A843080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 20, 2007; 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.