MEDICARE: KAZAK MARS INC

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1396984621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAZAK MARS INC

Provider Business Mailing Address
First Line	:	7037 HAYVENHURST AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-3802
Country	:	US
Telephone Number	:	818-375-1033
Fax Number	:	818-375-1038

Provider Business Practice Location Address
First Line	:	7037 HAYVENHURST AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-3802
Country	:	US
Telephone Number	:	818-375-1033
Fax Number	:	818-375-1038

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAN SADOVSKY
Credential	:
Telephone Number	:	800-296-1551

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	02/10/2009

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Directions to “KAZAK MARS INC ” Practice Location

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