Provider Demographics
NPI:1285705905
Name:MELIKIAN, JIVAN (MD)
Entity type:Individual
Prefix:
First Name:JIVAN
Middle Name:
Last Name:MELIKIAN
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 1:1530 E CHEVY CHASE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4163
Mailing Address - Country:US
Mailing Address - Phone:818-546-8644
Mailing Address - Fax:818-546-2494
Practice Address - Street 1:1530 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4163
Practice Address - Country:US
Practice Address - Phone:818-546-8644
Practice Address - Fax:818-546-2494
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45112207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A45112Medicaid
CAA88615Medicare UPIN