Healthcare Provider Details

I. General information

NPI: 1700879384
Provider Name (Legal Business Name): SAMUEL KOJOGLANIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23929 MCBEAN PKWY SUITE 216
VALENCIA CA
91355-4466
US

IV. Provider business mailing address

15243 VANOWEN ST SUITE 301
VAN NUYS CA
91405-3605
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-1534
  • Fax: 661-284-3670
Mailing address:
  • Phone: 818-782-5041
  • Fax: 818-782-4864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA60872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: