MEDICARE: KEVORK ALEK KHADARIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	A164332	CA

General Provider Information

NPI Number	:	1245734789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVORK ALEK KHADARIAN MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	19950 RINALDI ST STE 300
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4254
Country	:	US
Telephone Number	:	818-271-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	08/27/2024

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