Provider Demographics
NPI:1720812878
Name:KODOKIAN, ALEXANDER KEVORK (DPM)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:KEVORK
Last Name:KODOKIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 VIOLET DR
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1782
Mailing Address - Country:US
Mailing Address - Phone:610-716-4301
Mailing Address - Fax:
Practice Address - Street 1:2525 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1705
Practice Address - Country:US
Practice Address - Phone:718-692-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP129534213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery