Basic Information
| Provider Information | |||||||||
| NPI: | 1922116664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGAJANIAN | ||||||||
| FirstName: | RICHY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18000 STUDEBAKER RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627353226 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Practice Location | |||||||||
| Address1: | 11480 BROOKSHIRE AVE | ||||||||
| Address2: | STE 309 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902415018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628691201 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 18467 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 45450 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 332B00000X | 6498490001 | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207RH0003X | A70830 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00A708300 | 05 | CA | MEDICAID |