Healthcare Provider Details

I. General information

NPI: 1386643815
Provider Name (Legal Business Name): JOSEPH KERENDIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 DEVONSHIRE ST SUITE 307
NORTHRIDGE CA
91325-1600
US

IV. Provider business mailing address

17075 DEVONSHIRE ST SUITE 307
NORTHRIDGE CA
91325-1600
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-5551
  • Fax: 818-832-0124
Mailing address:
  • Phone: 818-832-5551
  • Fax: 818-832-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG75439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: