Healthcare Provider Details

I. General information

NPI: 1275628901
Provider Name (Legal Business Name): LEON KELECHIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4668 HOLLYWOOD BLVD.
LOS ANGELES CA
90027-5408
US

IV. Provider business mailing address

4668 HOLLYWOOD BLVD.
LOS ANGELES CA
90027-5408
US

V. Phone/Fax

Practice location:
  • Phone: 323-663-2481
  • Fax: 323-663-2481
Mailing address:
  • Phone: 323-663-2481
  • Fax: 323-663-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number834952-18
License Number StateCA

VIII. Authorized Official

Name: MR. LEON KELESHIAN
Title or Position: OWNER
Credential:
Phone: 323-663-2481