Provider Demographics
NPI:1275504995
Name:JOSEPH KERENDIAN, MD, INC
Entity Type:Organization
Organization Name:JOSEPH KERENDIAN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KERENDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-832-5551
Mailing Address - Street 1:17075 DEVONSHIRE ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5408
Mailing Address - Country:US
Mailing Address - Phone:818-832-5551
Mailing Address - Fax:818-832-0124
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:SUITE 307
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-832-5551
Practice Address - Fax:818-832-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75439207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G754390Medicaid
CA00G754391Medicaid
CA00G754391OtherBLUE SHIELD
CA00G754392Medicaid
CA00G754390OtherBLUE SHIELD
CA00G754392OtherBLUE SHIELD
CA00G754392Medicaid
CA00G754391OtherBLUE SHIELD
CAG75439CMedicare ID - Type Unspecified
CA00G754392OtherBLUE SHIELD