Healthcare Provider Details

I. General information

NPI: 1013213990
Provider Name (Legal Business Name): AVEDIS KOJAYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 10/14/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10945 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3717
US

IV. Provider business mailing address

PO BOX 5155
GLENDALE CA
91221-2155
US

V. Phone/Fax

Practice location:
  • Phone: 818-487-0119
  • Fax:
Mailing address:
  • Phone: 818-823-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: