Healthcare Provider Details

I. General information

NPI: 1598740649
Provider Name (Legal Business Name): JOHN KHOZOZIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/20/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CANTON ST SUITE 325
WESTWOOD MA
02090-2321
US

IV. Provider business mailing address

BOSTON OUTPATIENT SURGICAL SUITES 840 WINTER ST, 3RD FLOOR
WALTHAM MA
02451
US

V. Phone/Fax

Practice location:
  • Phone: 781-407-7713
  • Fax: 781-407-0998
Mailing address:
  • Phone: 781-209-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number213767
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: