Healthcare Provider Details

I. General information

NPI: 1477611606
Provider Name (Legal Business Name): LEVON KEDERIAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N CENTRAL AVE SUITE 900
GLENDALE CA
91203-3905
US

IV. Provider business mailing address

500 N CENTRAL AVE SUITE 900
GLENDALE CA
91203-3905
US

V. Phone/Fax

Practice location:
  • Phone: 818-363-2424
  • Fax:
Mailing address:
  • Phone: 818-363-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: