Individual
ARA A KARDASHIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15503 VENTURA BLVD STE 170, ENCINO, CA 91436-3145
(818) 618-1484
(818) 461-8105
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A123325
CA
207RG0100X
Gastroenterology Physician
Primary
A123325
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113846
SID # 113846
CA
Enumeration date
01/24/2012
Last updated
09/03/2019
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