MEDICARE: TER- ZAKARIAN MEDICAL CLINIC AND LABORATORY SERVICES INC

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	207Q00000X	Family Medicine Physician	A455970	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	:	1477735603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TER- ZAKARIAN MEDICAL CLINIC AND LABORATORY SERVICES INC

Provider Business Mailing Address
First Line	:	5250 SANTA MONICA BLVD
Second Line	:	310
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1252
Country	:	US
Telephone Number	:	323-663-9831
Fax Number	:	323-668-0955

Provider Business Practice Location Address
First Line	:	5250 SANTA MONICA BLVD
Second Line	:	310
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1252
Country	:	US
Telephone Number	:	323-663-9831
Fax Number	:	323-668-0955

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOVANES JOHN TER-ZAKARIAN
Credential	:	M.D.
Telephone Number	:	323-663-9831

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	12/10/2009

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