Provider Demographics
NPI:1982797775
Name:KASSARDJIAN, NORMA HAGOP (MD)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:HAGOP
Last Name:KASSARDJIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:NORMA
Other - Middle Name:HAGOP
Other - Last Name:FAKJIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30280 RANCHO VIEJO ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-248-1632
Mailing Address - Fax:949-248-7321
Practice Address - Street 1:30280 RANCHO VIEJO ROAD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-248-1632
Practice Address - Fax:949-248-7321
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65294207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G652940OtherBLUE SHIELD
CA92675C004OtherTRICARE WPS
CA92675C004OtherTRICARE WPS
E58417Medicare UPIN