Individual
SUSAN KERKOUTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10833 LE CONTE AVE, RM: 13-145G CHS, LOS ANGELES, CA 90095-3075
(310) 825-5719
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 825-5719
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
A110388
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0A1103880
—
CA
Enumeration date
06/10/2010
Last updated
10/03/2013
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