Basic Information
| Provider Information | |||||||||
| NPI: | 1700879384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOJOGLANIAN | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15243 VANOWEN ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187825041 | ||||||||
| FaxNumber: | 8187824864 | ||||||||
| Practice Location | |||||||||
| Address1: | 23929 MCBEAN PKWY | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913554466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612591534 | ||||||||
| FaxNumber: | 6612843670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | A60872 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00A608720 | 05 | CA | MEDICAID |