Provider Demographics
NPI:1003814823
Name:MURACHANIAN, KENNETH ALEX (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALEX
Last Name:MURACHANIAN
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 1:6060 N FOUNTAIN PLAZA DR STE 270
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7873
Mailing Address - Country:US
Mailing Address - Phone:520-229-2578
Mailing Address - Fax:
Practice Address - Street 1:6060 N FOUNTAIN PLAZA DR STE 270
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7873
Practice Address - Country:US
Practice Address - Phone:520-229-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64167207R00000X
AZ5270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641670OtherBLUE SHIELD OF CALIFORNIA
CA00A641670Medicaid
CA110207223OtherRAILROAD MEDICARE
CA00A641670OtherBLUE SHIELD OF CALIFORNIA
CAG98677Medicare UPIN
CAFA074ZMedicare PIN
CA00A641670Medicaid