MEDICARE: HAGOP JACK KAPUTYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	PZUC-20070756	CA

General Provider Information

NPI Number	:	1033384532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAGOP JACK KAPUTYAN

Provider Business Mailing Address
First Line	:	828 E COLORADO ST
Second Line	:	SUITE B
City	:	GLENDALE
State	:	CA
Zip	:	91205
Country	:	US
Telephone Number	:	818-245-8300
Fax Number	:	818-245-8301

Provider Business Practice Location Address
First Line	:	828 E COLORADO ST
Second Line	:	SUITE B
City	:	GLENDALE
State	:	CA
Zip	:	91205-4519
Country	:	US
Telephone Number	:	818-245-8300
Fax Number	:	818-245-8301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	01/05/2009

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