Provider Demographics
NPI:1184693889
Name:MELKO MEDICAL DIAGNOSTIC, INC
Entity type:Organization
Organization Name:MELKO MEDICAL DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RDMS, RDCS, RVT
Authorized Official - Phone:818-990-0555
Mailing Address - Street 1:18143 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7148
Mailing Address - Country:US
Mailing Address - Phone:818-448-8920
Mailing Address - Fax:818-990-0584
Practice Address - Street 1:18143 ERWIN ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335-7148
Practice Address - Country:US
Practice Address - Phone:818-990-0555
Practice Address - Fax:818-990-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y48979Medicare UPIN
TG549Medicare ID - Type Unspecified