MEDICARE: LEVON ANTOSSYAN 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	261Q00000X	Clinic/Center	A053324	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	:	1932150224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVON ANTOSSYAN INC

Provider Business Mailing Address
First Line	:	1204 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2504
Country	:	US
Telephone Number	:	818-551-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2504
Country	:	US
Telephone Number	:	818-551-0001
Fax Number	:

Authorized Official
Title or Position	:	OWENER PHYSICIAN
Name	:	LEVON ANTOSSYAN
Credential	:	M.D.
Telephone Number	:	818-551-0001

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/20/2009

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