Healthcare Provider Details

I. General information

NPI: 1073758645
Provider Name (Legal Business Name): SARKIS A KAAKIJIAN M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE SUITE 318
GLENDALE CA
91204-2530
US

IV. Provider business mailing address

1500 S CENTRAL AVE SUITE 318
GLENDALE CA
91204-2530
US

V. Phone/Fax

Practice location:
  • Phone: 818-548-5437
  • Fax: 818-548-5445
Mailing address:
  • Phone: 818-548-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARKIS A KAAKIJIAN
Title or Position: PRESIDANT
Credential: MD
Phone: 818-548-5437