Provider Demographics
NPI:1528377694
Name:SHANT KAZAZIAN MD INC.
Entity Type:Organization
Organization Name:SHANT KAZAZIAN MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-304-0975
Mailing Address - Street 1:204 E CHEVY CHASE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3181
Mailing Address - Country:US
Mailing Address - Phone:818-545-9090
Mailing Address - Fax:818-545-9098
Practice Address - Street 1:204 E CHEVY CHASE DR STE 2
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3181
Practice Address - Country:US
Practice Address - Phone:818-545-9090
Practice Address - Fax:818-545-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty