MEDICARE: LEON KELECHIAN

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	2085U0001X	Diagnostic Ultrasound Physician	834952-18	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275628901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEON KELECHIAN

Provider Business Mailing Address
First Line	:	4668 HOLLYWOOD BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5408
Country	:	US
Telephone Number	:	323-663-2481
Fax Number	:	323-663-2481

Provider Business Practice Location Address
First Line	:	4668 HOLLYWOOD BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5408
Country	:	US
Telephone Number	:	323-663-2481
Fax Number	:	323-663-2481

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LEON KELESHIAN
Credential	:
Telephone Number	:	323-663-2481

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/18/2008

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