Healthcare Provider Details

I. General information

NPI: 1952398265
Provider Name (Legal Business Name): M & K PODIATRIC MEDICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4314 W VICTORY BLVD
BURBANK CA
91505-1334
US

IV. Provider business mailing address

4314 W VICTORY BLVD
BURBANK CA
91505-1334
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-6611
  • Fax: 818-843-6656
Mailing address:
  • Phone: 818-843-6611
  • Fax: 818-843-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberE4536
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4536
License Number StateCA

VIII. Authorized Official

Name: DR. ARA KELEKIAN
Title or Position: PARTNER
Credential: D.P.M.
Phone: 323-270-0295