Provider Demographics
NPI:1225052590
Name:MELKONIAN, KAYZAK H
Entity Type:Individual
Prefix:MR
First Name:KAYZAK
Middle Name:H
Last Name:MELKONIAN
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 1:1727 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1312
Mailing Address - Country:US
Mailing Address - Phone:818-729-9009
Mailing Address - Fax:818-729-9002
Practice Address - Street 1:1727 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1312
Practice Address - Country:US
Practice Address - Phone:818-729-9009
Practice Address - Fax:818-729-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA830411505332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5391400001Medicare NSC