Provider Demographics
NPI:1104135391
Name:ABOVIAN, VIGEN VICK (MD)
Entity type:Individual
Prefix:
First Name:VIGEN
Middle Name:VICK
Last Name:ABOVIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5869
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-5869
Mailing Address - Country:US
Mailing Address - Phone:818-548-8001
Mailing Address - Fax:
Practice Address - Street 1:435 ARDEN AVE STE 330
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4016
Practice Address - Country:US
Practice Address - Phone:818-548-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine