OrganizationMissak Kltchian Md Inc.Internal MedicineAllopathic & Osteopathic PhysiciansPractice Address4645 Hollywood Blvd Ste 2/4, Los Angeles, CA 90027-5455(323) 661-4500PECOS EnrollmentBased on the most recent information from CMS, provider Missak Kltchian Md Inc. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1932695079Provider TypeOrganizationFull NameMissak Kltchian Md Inc.SubpartNoEnumeration Date7/2/2018Last Updated7/2/2018Contact InformationPractice LocationPractice Address4645 Hollywood Blvd Ste 2/4, Los Angeles, CA 90027-5455Phone(323) 661-4500Fax(323) 661-3260Mailing LocationMailing Address4645 Hollywood Blvd Ste 2/4, Los Angeles, CA 90027-5455Phone(323) 661-4500Fax(323) 661-3260Authorized OfficialNameKltchian, Missak (Md / President)Phone(323) 661-4500Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseA52368CaliforniaProvider IdentifiersIDDescriptionIssuerID00A52368DescriptionMedicaidIssuerUnlistedCaliforniaID1578901237DescriptionOtherIssuerMEDICARECaliforniaID1255359840DescriptionOtherIssuerMEDICARECalifornia