Healthcare Provider Details

I. General information

NPI: 1710516042
Provider Name (Legal Business Name): NEXT GENERATION FOOT AND ANKLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 202
GLENDALE CA
91204-4375
US

IV. Provider business mailing address

800 S CENTRAL AVE STE 202
GLENDALE CA
91204-4375
US

V. Phone/Fax

Practice location:
  • Phone: 818-927-3668
  • Fax: 818-927-3686
Mailing address:
  • Phone: 818-927-3668
  • Fax: 818-927-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SAMVEL HOVANY KESHISHYAN
Title or Position: OWNER
Credential: DPM
Phone: 818-927-3668