Provider Demographics
NPI:1790939643
Name:SARDARYAN, LEVON
Entity Type:Individual
Prefix:MR
First Name:LEVON
Middle Name:
Last Name:SARDARYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DBA
Other - Middle Name:GENEX
Other - Last Name:LABORATORY SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1301 N SAN FERNANDO BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4236
Mailing Address - Country:US
Mailing Address - Phone:818-557-0004
Mailing Address - Fax:818-557-0040
Practice Address - Street 1:1301 N SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4236
Practice Address - Country:US
Practice Address - Phone:818-557-0004
Practice Address - Fax:818-557-0040
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00337819291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADBAOtherDBA GENEX LABORATORY SERVICES
CA05D1089622OtherCLIA
CACLF00337819OtherSTATE LICENSE
CABL898AOtherPTAN
CADBAOtherDBA GENEX LABORATORY SERVICES