MEDICARE: SIRANOUSH H KEVORKIAN 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	208D00000X	General Practice Physician	A35663	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457416265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRANOUSH H KEVORKIAN MD

Provider Business Mailing Address
First Line	:	425 PALM DRIVE
Second Line	:	UNIT 1
City	:	GLENDALE
State	:	CA
Zip	:	91202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8781 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-2406
Country	:	US
Telephone Number	:	818-920-0808
Fax Number	:	818-920-6603

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/08/2007

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