Provider Demographics
NPI:1831134162
Name:KLIJIAN, ARA S (MD)
Entity Type:Individual
Prefix:
First Name:ARA
Middle Name:S
Last Name:KLIJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 BERGER AVE
Mailing Address - Street 2:SUITE# 250
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4233
Mailing Address - Country:US
Mailing Address - Phone:858-715-0303
Mailing Address - Fax:858-492-1377
Practice Address - Street 1:3131 BERGER AVE
Practice Address - Street 2:SUITE# 250
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4233
Practice Address - Country:US
Practice Address - Phone:858-715-0303
Practice Address - Fax:858-492-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54227208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A542270Medicaid
CA00A542270Medicaid
CAA54227Medicare ID - Type Unspecified