Provider Demographics
NPI:1598740649
Name:KHOZOZIAN, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:KHOZOZIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:BOSTON OUTPATIENT SURGICAL SUITES
Mailing Address - Street 2:840 WINTER ST, 3RD FLOOR
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:781-209-5645
Mailing Address - Fax:
Practice Address - Street 1:690 CANTON ST
Practice Address - Street 2:SUITE 325
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2321
Practice Address - Country:US
Practice Address - Phone:781-407-7713
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA213767207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2061881Medicaid
I09482Medicare UPIN
MAA37034Medicare PIN