Healthcare Provider Details

I. General information

NPI: 1306026034
Provider Name (Legal Business Name): GARABED KAYEKJIAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18250 ROSCOE BLVD STE 130
NORTHRIDGE CA
91325-4264
US

IV. Provider business mailing address

18250 ROSCOE BLVD STE 130
NORTHRIDGE CA
91325-4264
US

V. Phone/Fax

Practice location:
  • Phone: 818-998-8097
  • Fax: 818-998-6517
Mailing address:
  • Phone: 818-998-8097
  • Fax: 818-998-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA54072
License Number StateCA

VIII. Authorized Official

Name: DR. GARABED KAYEKJIAN
Title or Position: OWNER
Credential: M.D.
Phone: 818-998-8097