| Shine Mmg | |
|
450 N Brand Blvd Ste 625a Glendale CA 91203-2347 | |
| (818) 745-0070 | |
| (818) 745-0065 |
| Full Name | Shine Mmg |
|---|---|
| Speciality | Family Medicine |
| Location | 450 N Brand Blvd Ste 625a, Glendale, California |
| Authorized Official Name and Position | Emil Golub (CFO) |
| Authorized Official Contact | 4242046004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Mmg 450 N Brand Blvd Ste 625a Glendale CA 91203-2347 Ph: (818) 745-0070 | Shine Mmg 450 N Brand Blvd Ste 625a Glendale CA 91203-2347 Ph: (818) 745-0070 |
| NPI Number | 1053930248 |
|---|---|
| Provider Enumeration Date | 04/08/2020 |
| Last Update Date | 04/08/2020 |
| Certification Date | 04/08/2020 |
| Medicare PECOS PAC ID | 6103257282 |
|---|---|
| Medicare Enrollment ID | O20200505000514 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053930248 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Zachary Harris Lutsky |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528019205 PECOS PAC ID: 3971531062 Enrollment ID: I20050729000962 |
| Provider Name | Gihan S Abdel-samed |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306884754 PECOS PAC ID: 0042239626 Enrollment ID: I20151204000520 |
| Provider Name | Jae Woo Seo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1265070023 PECOS PAC ID: 2365870615 Enrollment ID: I20200319001364 |
| Provider Name | Virgil C Junio |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083259386 PECOS PAC ID: 2567899453 Enrollment ID: I20200324000940 |
| Provider Name | Analiza Farahbakhsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780229674 PECOS PAC ID: 5799113775 Enrollment ID: I20200325002950 |
| Provider Name | Marylou Aclan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881162147 PECOS PAC ID: 4183059595 Enrollment ID: I20200408004205 |
| Provider Name | Elma Khechemyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962022319 PECOS PAC ID: 8628345576 Enrollment ID: I20200702001401 |
| Provider Name | Doris Yaghoubtil |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649817610 PECOS PAC ID: 3870919509 Enrollment ID: I20200806001278 |
| Provider Name | Da Som Choi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407484058 PECOS PAC ID: 5294153730 Enrollment ID: I20210121002728 |
| Provider Name | Ricky Tran |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386242543 PECOS PAC ID: 6507272820 Enrollment ID: I20210311002176 |
| Provider Name | Lucy Vardapetyan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164018966 PECOS PAC ID: 1254747355 Enrollment ID: I20210316001460 |
| Provider Name | Levon Maghakyan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588258008 PECOS PAC ID: 3971911496 Enrollment ID: I20210422001756 |
| Provider Name | Amanda Spino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750939526 PECOS PAC ID: 0547679714 Enrollment ID: I20210429002840 |
| Provider Name | Cameo Denise Cozart-chance |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619903135 PECOS PAC ID: 6406824838 Enrollment ID: I20210830002065 |
| Provider Name | Benjamin J Shannon-alferes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487146593 PECOS PAC ID: 3274930714 Enrollment ID: I20210924002583 |
| Provider Name | Jonathan Yaghoubian |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609361500 PECOS PAC ID: 2264820968 Enrollment ID: I20211029001518 |
| Provider Name | Claudia C Talbot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376206797 PECOS PAC ID: 6002206521 Enrollment ID: I20211123003195 |
| Provider Name | Mari a Hareyan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1255004503 PECOS PAC ID: 5294126637 Enrollment ID: I20211220001624 |
| Provider Name | Kristopher Baluyot |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1215402185 PECOS PAC ID: 5799179305 Enrollment ID: I20220224002399 |
| Provider Name | Natalie Samuelian |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1871250845 PECOS PAC ID: 8628463510 Enrollment ID: I20220310002014 |
| Provider Name | Margarita Mouradian |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881358356 PECOS PAC ID: 2163817370 Enrollment ID: I20220324000700 |
| Provider Name | Asmik Cholakian |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649927039 PECOS PAC ID: 1456748177 Enrollment ID: I20220428000438 |
| Provider Name | Mihai D Zaiat |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1447874268 PECOS PAC ID: 0143693044 Enrollment ID: I20230223001449 |
| Provider Name | Faith O Rivera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518677566 PECOS PAC ID: 5597125682 Enrollment ID: I20230720003636 |
| Provider Name | Voottisin Michael Pisarnwongs |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124739354 PECOS PAC ID: 0446611511 Enrollment ID: I20230804003477 |
| Provider Name | Majarlika L Junio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932835063 PECOS PAC ID: 3678917481 Enrollment ID: I20240220004456 |
| Provider Name | Bianca L Florece |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235908401 PECOS PAC ID: 9032555776 Enrollment ID: I20240315002550 |
| Provider Name | Tigranuhi T Tadevosyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750152211 PECOS PAC ID: 6305284365 Enrollment ID: I20240606002843 |
| Provider Name | Elda Petrosyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396506283 PECOS PAC ID: 7618419029 Enrollment ID: I20240612002805 |
| Provider Name | Suzy Arevyan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174390306 PECOS PAC ID: 5294272654 Enrollment ID: I20240802000894 |
| Provider Name | Macy Javaherifar |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1295563203 PECOS PAC ID: 8527596162 Enrollment ID: I20250110001335 |
| Provider Name | Erika Montalvo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497561443 PECOS PAC ID: 7113442120 Enrollment ID: I20250422002213 |
Silva Karchikian, M.D. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 410 Arden Ave, Suite 101, Glendale, CA 91203 Phone: 818-549-9305 Fax: 818-662-8812 |
Glendale Premier Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 222 W Eulalia St, #201, Glendale, CA 91204 Phone: 818-240-0601 Fax: 818-240-0687 |
Glenoaks Urgent Care Medical Group, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1100 W Glenoaks Blvd, Glendale, CA 91202 Phone: 818-242-3333 Fax: 818-546-1056 |
Rubin Manavi, MD, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 214 N Central Ave, Glendale, CA 91203 Phone: 818-241-0970 Fax: 818-638-0024 |
Armen Nercessian DO Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1139 N Brand Blvd Ste C, Glendale, CA 91202 Phone: 818-552-2011 Fax: 818-552-2012 |
Wound Care Solutions of California Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1800 S Brand Blvd Ste 119, Glendale, CA 91204 Phone: 818-206-5141 |