Provider Demographics
NPI:1841367091
Name:KOTOYAN, MARCOS (MD)
Entity type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
Last Name:KOTOYAN
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 1:1300 NORTH VERMONT AVENUE
Mailing Address - Street 2:SUITE 804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-662-9711
Mailing Address - Fax:323-662-9731
Practice Address - Street 1:1300 NORTH VERMONT AVENUE
Practice Address - Street 2:SUITE 804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-662-9711
Practice Address - Fax:323-662-9731
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA030078Medicaid