Provider Demographics
NPI:1467498188
Name:KOJIAN, BEDROS H (MD)
Entity type:Individual
Prefix:
First Name:BEDROS
Middle Name:H
Last Name:KOJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-997-4110
Mailing Address - Fax:714-997-4611
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 308
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-997-4110
Practice Address - Fax:714-997-4611
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA33708174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337080Medicaid
CAA27226Medicare UPIN
CAA33708Medicare ID - Type Unspecified