Provider Demographics
NPI:1851559546
Name:SAMUEL A KOJOGLANIAN MD FACC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAMUEL A KOJOGLANIAN MD FACC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERVENTIONAL CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOJOGLANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-259-1711
Mailing Address - Street 1:24868 APPLE ST STE 103-104
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5037
Mailing Address - Country:US
Mailing Address - Phone:661-259-1711
Mailing Address - Fax:661-259-1911
Practice Address - Street 1:24868 APPLE ST STE 103-104
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5037
Practice Address - Country:US
Practice Address - Phone:661-259-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60872207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU771Medicare UPIN