MEDICARE: SAMUEL KOJOGLANIAN 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	207RC0000X	Cardiovascular Disease Physician	A60872	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	:	1700879384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL KOJOGLANIAN M.D.

Provider Business Mailing Address
First Line	:	15243 VANOWEN ST
Second Line	:	SUITE 301
City	:	VAN NUYS
State	:	CA
Zip	:	91405-3605
Country	:	US
Telephone Number	:	818-782-5041
Fax Number	:	818-782-4864

Provider Business Practice Location Address
First Line	:	23929 MCBEAN PKWY
Second Line	:	SUITE 216
City	:	VALENCIA
State	:	CA
Zip	:	91355-4466
Country	:	US
Telephone Number	:	661-259-1534
Fax Number	:	661-284-3670

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	07/11/2008

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