Provider Demographics
NPI:1699222851
Name:DR. KAZARIAN PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:DR. KAZARIAN PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-632-3502
Mailing Address - Street 1:8337 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3809
Mailing Address - Country:US
Mailing Address - Phone:818-632-3502
Mailing Address - Fax:
Practice Address - Street 1:8337 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3809
Practice Address - Country:US
Practice Address - Phone:818-632-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104760261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care