Provider Demographics
NPI:1063751899
Name:KALANJIAN, JACK ANTOUN
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:ANTOUN
Last Name:KALANJIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E TULARE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-1513
Mailing Address - Country:US
Mailing Address - Phone:559-300-9448
Mailing Address - Fax:888-355-9911
Practice Address - Street 1:1920 W PRINCETON AVE STE 20
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4473
Practice Address - Country:US
Practice Address - Phone:559-300-9448
Practice Address - Fax:888-355-9911
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver