Provider Demographics
NPI:1447145727
Name:KESTENIAN, SOPHIA (OD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:KESTENIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 GRANGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1122
Mailing Address - Country:US
Mailing Address - Phone:818-476-2233
Mailing Address - Fax:
Practice Address - Street 1:804 S VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2427
Practice Address - Country:US
Practice Address - Phone:818-476-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist