Healthcare Provider Details

I. General information

NPI: 1902995053
Provider Name (Legal Business Name): TSOLAG JIMMY KAZANDJIAN D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E ORANGE GROVE AVE STE B
BURBANK CA
91502
US

IV. Provider business mailing address

265 E ORANGE GROVE AVE STE B
BURBANK CA
91502-1229
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-9291
  • Fax: 818-660-2590
Mailing address:
  • Phone: 818-500-9291
  • Fax: 818-660-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30283
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: