Provider Demographics
NPI:1952756256
Name:DJENDEREDJIAN, LEVON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEVON
Middle Name:
Last Name:DJENDEREDJIAN
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 1:1855 SAN MIGUEL DR STE 28
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5298
Mailing Address - Country:US
Mailing Address - Phone:310-940-3292
Mailing Address - Fax:
Practice Address - Street 1:1855 SAN MIGUEL DR STE 28
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5298
Practice Address - Country:US
Practice Address - Phone:310-940-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298969207W00000X
CAA172266207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist