Provider Demographics
NPI:1962702167
Name:EPIC AESTHETIC MEDICAL INSTITUTE INC.
Entity type:Organization
Organization Name:EPIC AESTHETIC MEDICAL INSTITUTE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVAHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-501-3366
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 815
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-501-3366
Mailing Address - Fax:818-906-7961
Practice Address - Street 1:11349 SATICOY ST
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4700
Practice Address - Country:US
Practice Address - Phone:818-982-5750
Practice Address - Fax:818-982-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8083208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty