Provider Demographics
NPI:1659721850
Name:KESHISHYAN, SAMVEL (DPM)
Entity Type:Individual
Prefix:
First Name:SAMVEL
Middle Name:
Last Name:KESHISHYAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CENTRAL AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4375
Mailing Address - Country:US
Mailing Address - Phone:818-927-3668
Mailing Address - Fax:818-927-3686
Practice Address - Street 1:800 S CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4375
Practice Address - Country:US
Practice Address - Phone:818-927-3668
Practice Address - Fax:818-927-3686
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5652213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery