Basic Information
| Provider Information | |||||||||
| NPI: | 1992293211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALKHASIAN | ||||||||
| FirstName: | ARMEN | ||||||||
| MiddleName: | MASIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MALKHASIAN | ||||||||
| OtherFirstName: | ARMIN | ||||||||
| OtherMiddleName: | MASEES YARWANT | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12223 HIGHLAND AVE STE 106-526 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917392574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146763880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3865 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146763880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2018 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101270458 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A173699 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.