Provider Demographics
NPI:1083816375
Name:KESTENIAN, HAMBARTSUM H
Entity Type:Individual
Prefix:MR
First Name:HAMBARTSUM
Middle Name:H
Last Name:KESTENIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 GRANGEMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1122
Mailing Address - Country:US
Mailing Address - Phone:818-842-4747
Mailing Address - Fax:818-843-0065
Practice Address - Street 1:804 S VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2427
Practice Address - Country:US
Practice Address - Phone:818-842-4747
Practice Address - Fax:818-843-0065
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6664156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX0066640Medicaid