Provider Demographics
NPI:1699780072
Name:GHAZAR G ZOKIAN
Entity type:Organization
Organization Name:GHAZAR G ZOKIAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GHAZAR
Authorized Official - Middle Name:GUS
Authorized Official - Last Name:ZOKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-1600
Mailing Address - Street 1:2930 HONOLULU AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3979
Mailing Address - Country:US
Mailing Address - Phone:818-541-6800
Mailing Address - Fax:818-541-6801
Practice Address - Street 1:2930 HONOLULU AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3979
Practice Address - Country:US
Practice Address - Phone:818-541-6800
Practice Address - Fax:818-541-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100791332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01764FMedicaid