Provider Demographics
NPI:1386643815
Name:KERENDIAN, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KERENDIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:91325-1600
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75439207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G754390OtherBLUE SHIELD PROVIDER NO
CA00G754390Medicaid
CA00G754391OtherBLUE SHIELD PROVIDER NO
CA00G754392OtherBLUE SHIELD PROVIDER NO
CA00G754392Medicaid
CA00G75491Medicaid
CA00G754391OtherBLUE SHIELD PROVIDER NO
CAG09573Medicare UPIN
CAG75439BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO
CA00G754390Medicaid