Provider Demographics
NPI:1962209577
Name:KELEDJIAN, ARAM
Entity type:Individual
Prefix:
First Name:ARAM
Middle Name:
Last Name:KELEDJIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E WINDSOR RD APT 3
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2438
Mailing Address - Country:US
Mailing Address - Phone:424-326-6112
Mailing Address - Fax:
Practice Address - Street 1:802 E WINDSOR RD APT 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2438
Practice Address - Country:US
Practice Address - Phone:424-326-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB7468857172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver