Provider Demographics
NPI:1184842197
Name:KALOOSTIAN, BILL (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:
Last Name:KALOOSTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:KALOOSTIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2242 CHESWIC LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1134
Mailing Address - Country:US
Mailing Address - Phone:323-663-7986
Mailing Address - Fax:
Practice Address - Street 1:2242 CHESWIC LN
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1134
Practice Address - Country:US
Practice Address - Phone:323-663-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine