Provider Demographics
NPI:1982646741
Name:KAZAZIAN, SHANT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANT
Middle Name:
Last Name:KAZAZIAN
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 1:204 E CHEVY CHASE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3157
Mailing Address - Country:US
Mailing Address - Phone:818-545-9090
Mailing Address - Fax:818-545-9098
Practice Address - Street 1:204 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3157
Practice Address - Country:US
Practice Address - Phone:818-545-9090
Practice Address - Fax:818-545-9098
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4186839Medicaid
CADT320ZMedicare UPIN