Provider Demographics
NPI:1871520726
Name:DANIELYAN, NOUNEH O (MD)
Entity type:Individual
Prefix:
First Name:NOUNEH
Middle Name:O
Last Name:DANIELYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NOUNEH
Other - Middle Name:OGANESI
Other - Last Name:DANIELYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5220 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 'E'
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1234
Mailing Address - Country:US
Mailing Address - Phone:323-913-9300
Mailing Address - Fax:323-660-9723
Practice Address - Street 1:5220 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 'E'
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1234
Practice Address - Country:US
Practice Address - Phone:323-913-9300
Practice Address - Fax:323-660-9723
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63520207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A635200Medicaid
A63520Medicare ID - Type Unspecified
CA00A635200Medicaid
A63520AMedicare ID - Type Unspecified