MEDICARE: DR. MICHAEL KASSARDJIAN D.O.

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	207N00000X	Dermatology Physician	20A11896	CA

General Provider Information

NPI Number	:	1740567981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KASSARDJIAN D.O.

Provider Business Mailing Address
First Line	:	23550 HAWTHORNE BLVD STE 200
Second Line	:	SUITE 200
City	:	TORRANCE
State	:	CA
Zip	:	90505-4722
Country	:	US
Telephone Number	:	310-326-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	23550 HAWTHORNE BLVD STE 200
Second Line	:	SUITE 200
City	:	TORRANCE
State	:	CA
Zip	:	90505-4722
Country	:	US
Telephone Number	:	310-326-2636
Fax Number	:

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	11/18/2014

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