Kevin Pezeshki MD Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A67148 Issued in CA

Legal business name

KEVIN PEZESHKI MD INC

Doing business as

SAN JOSEPH MEDICAL CLINIC

Practice address

13750 Victory Blvd
Van Nuys, CA 91401-2324

Phone

(818) 909-9955

Fax

(818) 909-0454

NPI assigned

Aug 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Pezeshki, M.D.NPI 1538207089

Title

Medical Director

Phone

(818) 909-9955

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SAN JOSEPH MEDICAL CLINIC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Pezeshki, MD

  • Obstetrics & Gynecology Physician
  • Van Nuys, CA
  • NPI 1538207089
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1184817496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13750 VICTORY BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012324",
            "telephone_number": "818-909-9955",
            "fax_number": "818-909-0454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13750 VICTORY BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012324",
            "telephone_number": "818-909-9955",
            "fax_number": "818-909-0454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN PEZESHKI MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "PEZESHKI",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-909-9955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A67148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0090250",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN JOSEPH MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Varteni Tina Ketikyan
• Anjila Keyo
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• Diana Khachatrian
• Karen Gary Khachatryan
• Khachikyan Health Services Inc

• Specialist in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.