Provider Demographics
NPI:1225488851
Name:DERMENDJIAN, BERJ (DO)
Entity type:Individual
Prefix:
First Name:BERJ
Middle Name:
Last Name:DERMENDJIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S GIBSON CT
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1127
Mailing Address - Country:US
Mailing Address - Phone:818-445-3666
Mailing Address - Fax:818-688-3151
Practice Address - Street 1:4955 VAN NUYS BLVD STE 308
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1811
Practice Address - Country:US
Practice Address - Phone:818-905-5583
Practice Address - Fax:818-688-3151
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18670207R00000X
NVDO2469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine