Provider Demographics
NPI:1134668601
Name:KESHISHIAN, TAGUHI
Entity type:Individual
Prefix:
First Name:TAGUHI
Middle Name:
Last Name:KESHISHIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 GROTON DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2422
Mailing Address - Country:US
Mailing Address - Phone:818-590-8557
Mailing Address - Fax:
Practice Address - Street 1:1577 E CHEVY CHASE DR STE 300
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4092
Practice Address - Country:US
Practice Address - Phone:818-590-8557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1112352085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA81-4505094OtherHEALTH CARE LA