MEDICARE: MR. ARMEN VARDANIAN L.A.C

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	171100000X	Acupuncturist	AC 11498	CA

General Provider Information

NPI Number	:	1063638625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARMEN VARDANIAN L.A.C

Provider Business Mailing Address
First Line	:	327 CHESTER ST
Second Line	:	APT O
City	:	GLENDALE
State	:	CA
Zip	:	91203-1535
Country	:	US
Telephone Number	:	818-731-8624
Fax Number	:	818-548-9209

Provider Business Practice Location Address
First Line	:	327 CHESTER ST
Second Line	:	APT O
City	:	GLENDALE
State	:	CA
Zip	:	91203-1535
Country	:	US
Telephone Number	:	818-731-8624
Fax Number	:	818-548-9209

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	04/10/2008

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