Healthcare Provider Details

I. General information

NPI: 1487831665
Provider Name (Legal Business Name): BEDROS H KOJIAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 308
ORANGE CA
92868-3838
US

IV. Provider business mailing address

1310 W STEWART DR STE 308
ORANGE CA
92868-3838
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-4110
  • Fax: 714-997-4611
Mailing address:
  • Phone: 714-997-4110
  • Fax: 714-997-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA33708
License Number StateCA

VIII. Authorized Official

Name: DR. BEDROS H KOJIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-997-4110