Provider Demographics
NPI:1194867473
Name:KARO ISAGHOLIAN MD INC
Entity Type:Organization
Organization Name:KARO ISAGHOLIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAGHOLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-244-8241
Mailing Address - Street 1:900 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3644
Mailing Address - Country:US
Mailing Address - Phone:818-244-8241
Mailing Address - Fax:818-244-8260
Practice Address - Street 1:900 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3644
Practice Address - Country:US
Practice Address - Phone:818-244-8241
Practice Address - Fax:818-244-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A738250Medicaid
CAA73578Medicare PIN
CA00A738250Medicaid
CA00A738250Medicaid