Provider Demographics
NPI:1700879384
Name:KOJOGLANIAN, SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:KOJOGLANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15243 VANOWEN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3605
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-782-4864
Practice Address - Street 1:23929 MCBEAN PKWY
Practice Address - Street 2:SUITE 216
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4466
Practice Address - Country:US
Practice Address - Phone:661-259-1534
Practice Address - Fax:661-284-3670
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60872207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A608720Medicaid
CAWA60872BMedicare ID - Type Unspecified
CAWA60872DMedicare ID - Type Unspecified
CAH38782Medicare UPIN
CAWA60872FMedicare ID - Type Unspecified
CAWA60872CMedicare ID - Type Unspecified
CA00A608720Medicaid