MEDICARE: JOSEPH KERENDIAN MD

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	207W00000X	Ophthalmology Physician	G75439	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G754390	OTHER	CA	BLUE SHIELD PROVIDER NO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00G754391	OTHER	CA	BLUE SHIELD PROVIDER NO
4	00G754392	OTHER	CA	BLUE SHIELD PROVIDER NO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386643815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH KERENDIAN MD

Provider Business Mailing Address
First Line	:	17075 DEVONSHIRE ST
Second Line	:	SUITE 307
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-1600
Country	:	US
Telephone Number	:	818-832-5551
Fax Number	:	818-832-0124

Provider Business Practice Location Address
First Line	:	17075 DEVONSHIRE ST
Second Line	:	SUITE 307
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-1600
Country	:	US
Telephone Number	:	818-832-5551
Fax Number	:	818-832-0124

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/09/2007

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Directions to “ JOSEPH KERENDIAN MD” Practice Location

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