Individual ProviderMissak KltchianInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address4645 Hollywood Blvd, Suite 4, Los Angeles, CA 90027-5455(323) 661-4500PECOS EnrollmentBased on the most recent information from CMS, provider Missak Kltchian is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1255359840Provider TypeIndividualFull NameKltchian, MissakCredentialMDGenderMaleSole ProprietorYesEnumeration Date7/18/2006Last Updated5/9/2011Contact InformationPractice LocationPractice Address4645 Hollywood Blvd, Suite 4, Los Angeles, CA 90027-5455Phone(323) 661-4500Fax(323) 661-3260Mailing LocationMailing Address4645 Hollywood Blvd, Suite 4, Los Angeles, CA 90027-5455Phone(323) 661-4500Fax(323) 661-3260Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseA52368CaliforniaProvider IdentifiersIDDescriptionIssuerID00A523681DescriptionMedicaidIssuerUnlistedCalifornia