MEDICARE: EDWIN OGHOORIAN, DPM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E4526	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ06981Z	OTHER		MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063447530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWIN OGHOORIAN, DPM, INC.

Provider Business Mailing Address
First Line	:	210 S GRAND AVE
Second Line	:	SUITE 307
City	:	GLENDORA
State	:	CA
Zip	:	91741-4205
Country	:	US
Telephone Number	:	626-914-4099
Fax Number	:	626-914-4119

Provider Business Practice Location Address
First Line	:	210 S GRAND AVE
Second Line	:	SUITE 307
City	:	GLENDORA
State	:	CA
Zip	:	91741-4205
Country	:	US
Telephone Number	:	626-914-4099
Fax Number	:	626-914-4119

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWIN OGHOORIAN
Credential	:	DPM
Telephone Number	:	626-914-4099

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/15/2008

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Directions to “EDWIN OGHOORIAN, DPM, INC. ” Practice Location

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