Provider Demographics
NPI:1295703320
Name:KAMAJIAN, STEVEN D (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:KAMAJIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 MONTROSE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1546
Mailing Address - Country:US
Mailing Address - Phone:818-957-2007
Mailing Address - Fax:
Practice Address - Street 1:2103 MONTROSE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1546
Practice Address - Country:US
Practice Address - Phone:818-957-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX46741Medicaid
CAB58255Medicare UPIN
CAB58255Medicare UPIN