Provider Demographics
NPI:1588926208
Name:KESHISHIAN, TENI JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:TENI
Middle Name:JENNIFER
Last Name:KESHISHIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9877 TUJUNGA CANYON PL
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2910
Mailing Address - Country:US
Mailing Address - Phone:818-319-5885
Mailing Address - Fax:
Practice Address - Street 1:380 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2248
Practice Address - Country:US
Practice Address - Phone:818-319-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist