MEDICARE: DR. TERRY DAVID KREKORIAN M.D.

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	207L00000X	Anesthesiology Physician	G075338	CA

General Provider Information

NPI Number	:	1396742813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY DAVID KREKORIAN M.D.

Provider Business Mailing Address
First Line	:	13160 MINDANAO WAY
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6358
Country	:	US
Telephone Number	:	310-574-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	13160 MINDANAO WAY
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6358
Country	:	US
Telephone Number	:	310-574-0440
Fax Number	:

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	06/13/2009

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