Healthcare Provider Details

I. General information

NPI: 1356268882
Provider Name (Legal Business Name): SARKIS SAM KALADZHYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7917 GREENBUSH AVE
PANORAMA CITY CA
91402-6423
US

IV. Provider business mailing address

7917 GREENBUSH AVE
PANORAMA CITY CA
91402-6423
US

V. Phone/Fax

Practice location:
  • Phone: 818-636-4904
  • Fax:
Mailing address:
  • Phone: 818-636-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: