Provider Demographics
NPI:1386838449
Name:ARA KELEKIAN DPM INC
Entity Type:Organization
Organization Name:ARA KELEKIAN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELEKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-270-0295
Mailing Address - Street 1:515 W BEVERLY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3665
Mailing Address - Country:US
Mailing Address - Phone:323-346-0996
Mailing Address - Fax:323-346-0986
Practice Address - Street 1:4314 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1334
Practice Address - Country:US
Practice Address - Phone:818-848-0535
Practice Address - Fax:818-843-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4536332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19642Medicare PIN
U99622Medicare UPIN
CA5649950002Medicare NSC