PACIFIC SHORES MEDICAL GROUP INC. NPI 1871642991

NPI Information

  • NPI: 1871642991
  • Provider Name: PACIFIC SHORES MEDICAL GROUP, INC.
  • Classification: Internal Medicine - 207RH0003X
  • Specialization: Hematology & Oncology
  • Entity Type: Organization
  • CLIA Number: 05D0953277
  • Address: 222 W EULALIA ST
    #100-B
    GLENDALE, CA
    ZIP 91204
  • Phone: (818) 637-7611

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NPI Details

PACIFIC SHORES MEDICAL GROUP, INC. is a hematology and oncology internal medicine in Glendale, CA. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. PACIFIC SHORES MEDICAL GROUP, INC. NPI is 1871642991. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

222 W EULALIA ST
#100-B
GLENDALE, CA
ZIP 91204-849
Phone: (818) 637-7611

The provider's authorized official is Nerses Simon Tchekmedyian .
The authorized official title is Ceo and has the following contact phone number (562) 590-0345.

The CLIA number assigned to this NPI record is 05D0953277 - other - multi-specialty clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/9/2007 and was last updated on 4/12/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RH0003XInternal MedicineHematology & OncologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GR0065541MEDICAIDCALIFORNIA
2W13494BMEDICARE PINCALIFORNIA
31118450004MEDICARE NSCCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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