Healthcare Provider Details

I. General information

NPI: 1144282807
Provider Name (Legal Business Name): VAHE G KERLAKIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 116
SANTA ANA CA
92705-3528
US

IV. Provider business mailing address

126 GREENBIAR DRIVE
MT CARMEL IL
62863
US

V. Phone/Fax

Practice location:
  • Phone: 714-973-1122
  • Fax: 714-547-6552
Mailing address:
  • Phone: 714-469-1953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA31287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: