Healthcare Provider Details

I. General information

NPI: 1982928875
Provider Name (Legal Business Name): SHAHEN KURESTIAN D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 206
GLENDALE CA
91204-4379
US

IV. Provider business mailing address

311 N VERDUGO RD
GLENDALE CA
91206-3944
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-2233
  • Fax: 818-240-2237
Mailing address:
  • Phone: 818-240-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-31558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: