| Derderyan Medical Group Inc. | |
|
4955 Van Nuys Blvd Ste 308 Sherman Oaks CA 91403-1811 | |
| (646) 552-1547 | |
| Not Available |
| Full Name | Derderyan Medical Group Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4955 Van Nuys Blvd Ste 308, Sherman Oaks, California |
| Authorized Official Name and Position | Edmond Varuzhan Derderyan (PRESIDENT/OWNER) |
| Authorized Official Contact | 6465521547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Derderyan Medical Group Inc. 4955 Van Nuys Blvd Ste 308 Sherman Oaks CA 91403-1811 Ph: () - | Derderyan Medical Group Inc. 4955 Van Nuys Blvd Ste 308 Sherman Oaks CA 91403-1811 Ph: (646) 552-1547 |
| NPI Number | 1457712309 |
|---|---|
| Provider Enumeration Date | 03/18/2016 |
| Last Update Date | 02/07/2021 |
| Medicare PECOS PAC ID | 8325347396 |
|---|---|
| Medicare Enrollment ID | O20160425002354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457712309 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Oleg Liakhovetski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154584316 PECOS PAC ID: 5395808281 Enrollment ID: I20090121000140 |
| Provider Name | Tammi L Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215256011 PECOS PAC ID: 0345432001 Enrollment ID: I20101013000482 |
| Provider Name | Keino A Rutherford |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497807853 PECOS PAC ID: 0345438008 Enrollment ID: I20101221001136 |
| Provider Name | Edmond V Derderian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114258944 PECOS PAC ID: 2668651340 Enrollment ID: I20110127000049 |
| Provider Name | Desirae A Mutuc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215393384 PECOS PAC ID: 2264721695 Enrollment ID: I20160525000435 |
| Provider Name | Gregory Andonian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942648118 PECOS PAC ID: 0143446260 Enrollment ID: I20160714002542 |
| Provider Name | Cheryl R Catalan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275089641 PECOS PAC ID: 0345528345 Enrollment ID: I20161026001034 |
| Provider Name | Christopher Gerard Negrete |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083157606 PECOS PAC ID: 6608158621 Enrollment ID: I20170126000515 |
| Provider Name | James Conrad J Contreras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033586870 PECOS PAC ID: 9436437829 Enrollment ID: I20170303002043 |
| Provider Name | Andrew Pascual |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871092254 PECOS PAC ID: 8729341524 Enrollment ID: I20180409001458 |
| Provider Name | Dorothy Olere Okesola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063980084 PECOS PAC ID: 8123388634 Enrollment ID: I20190207000921 |
| Provider Name | Hambartsoum Mekharian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265095921 PECOS PAC ID: 6800121005 Enrollment ID: I20190710002478 |
| Provider Name | Jason Wiguna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346731767 PECOS PAC ID: 6507289485 Enrollment ID: I20200710001373 |
Gary Schneider D O Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4835 Van Nuys Blvd Ste 109, Sherman Oaks, CA 91403 Phone: 818-905-9586 Fax: 818-905-0130 | |
Joey Brett Md A Professional Medical Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 13320 Riverside Dr, Suite 104, Sherman Oaks, CA 91423 Phone: 818-789-0034 Fax: 818-789-0042 | |
Ali Sheybani Medical Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4955 Van Nuys Blvd, Suite 405, Sherman Oaks, CA 91403 Phone: 818-464-4870 Fax: 818-464-4877 | |
Alberto X. Campain, M.d., A Professional Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4940 Van Nuys Blvd., Suite 200, Sherman Oaks, CA 91403 Phone: 818-528-1090 Fax: 818-528-1099 | |
Maximum Care Medical Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4910 Van Nuys Blvd, Suite 306, Sherman Oaks, CA 91403 Phone: 818-426-0886 | |
Peter P. Koenig, M.d., Incorporated Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4940 Van Nuys Blvd., Suite 200, Sherman Oaks, CA 91403 Phone: 818-528-1222 Fax: 828-528-1225 | |
Health West Medical Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14417 Burbank Blvd, Sherman Oaks, CA 91401 Phone: 818-786-3318 |