MEDICARE: MANDANA KAJIAN M.ED

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	103K00000X	Behavior Analyst	BA-0236	AZ

General Provider Information

NPI Number	:	1972056463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDANA KAJIAN M.ED

Provider Business Mailing Address
First Line	:	51 E MONTEREY WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2616
Country	:	US
Telephone Number	:	602-237-6653
Fax Number	:	602-957-3600

Provider Business Practice Location Address
First Line	:	51 E MONTEREY WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2616
Country	:	US
Telephone Number	:	602-237-6653
Fax Number	:	602-957-3600

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

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	08/01/2016

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