Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 6664 | CA |
NPI | 1083816375 |
---|---|
Provider Name | Mr. Hambartsum H Kestenian |
First Address | Glendale, CA 91206-1122 |
Second Address | Burbank, CA 91502-2427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX0066640 | (05) | CA |