Provider Demographics
NPI:1568287720
Name:KEVORKIAN, ILONA (BS, MS)
Entity type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:KEVORKIAN
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KEDREN COMMUNITY HEALTH
Mailing Address - Street 2:4211 SOUTH AVALON BLVD
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011
Mailing Address - Country:US
Mailing Address - Phone:213-831-5825
Mailing Address - Fax:
Practice Address - Street 1:KEDREN COMMUNITY HEALTH
Practice Address - Street 2:4211 SOUTH AVALON BLVD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:213-831-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker