MEDICARE: DZOVAK KAZANDJIAN PSYD

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	103TC0700X	Clinical Psychologist	PSY31603	CA

General Provider Information

NPI Number	:	1609329291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DZOVAK KAZANDJIAN PSYD

Provider Business Mailing Address
First Line	:	6101 OWENSMOUTH AVE # 6062
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30495 CANWOOD ST STE 101
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4331
Country	:	US
Telephone Number	:	818-707-7366
Fax Number	:

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

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	04/13/2020

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