| Vituity - Primary Care Glendale Pc | |
|
1560 E Chevy Chase Dr Ste 355 Glendale CA 91206-4159 | |
| (747) 212-3441 | |
| Not Available |
| Full Name | Vituity - Primary Care Glendale Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1560 E Chevy Chase Dr Ste 355, Glendale, California |
| Authorized Official Name and Position | Theophile G. Koury (PRESIDENT) |
| Authorized Official Contact | 5103502638 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vituity - Primary Care Glendale Pc 2100 Powell St Ste 400 Emeryville CA 94608-1826 Ph: (510) 350-2638 | Vituity - Primary Care Glendale Pc 1560 E Chevy Chase Dr Ste 355 Glendale CA 91206-4159 Ph: (747) 212-3441 |
| NPI Number | 1548876626 |
|---|---|
| Provider Enumeration Date | 09/23/2020 |
| Last Update Date | 06/16/2021 |
| Certification Date | 06/16/2021 |
| Medicare PECOS PAC ID | 0547680688 |
|---|---|
| Medicare Enrollment ID | O20201012001634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548876626 | NPI | - | NPPES |
| Provider Name | Sirvard Khanoyan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669424586 PECOS PAC ID: 9133181928 Enrollment ID: I20041103000620 |
| Provider Name | Brian D Kan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336177484 PECOS PAC ID: 8426133786 Enrollment ID: I20080311000291 |
| Provider Name | Janet A Cunningham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427000157 PECOS PAC ID: 4789571357 Enrollment ID: I20100728000105 |
| Provider Name | Jack N Yu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265485684 PECOS PAC ID: 5092849885 Enrollment ID: I20100816000605 |
| Provider Name | Meri Antossyan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457738460 PECOS PAC ID: 4082902192 Enrollment ID: I20161005001389 |
| Provider Name | Sarah Beaty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609235423 PECOS PAC ID: 6800183484 Enrollment ID: I20171019001102 |
| Provider Name | Charles C Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871036798 PECOS PAC ID: 3870878093 Enrollment ID: I20180717000671 |
| Provider Name | Araz M Melkonian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710423405 PECOS PAC ID: 0941546246 Enrollment ID: I20190108000986 |
| Provider Name | Brooke Harmssen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083110456 PECOS PAC ID: 0042615502 Enrollment ID: I20220909003099 |
| Provider Name | Molly Wilkerson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073171930 PECOS PAC ID: 2365841129 Enrollment ID: I20220920000715 |
| Provider Name | Jolie Cooperman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437618469 PECOS PAC ID: 0749669182 Enrollment ID: I20230728001297 |
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