Healthcare Provider Details

I. General information

NPI: 1447318043
Provider Name (Legal Business Name): OSHIN BOJALIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: OSHIN BOJALIAN M.D.

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N CENTRAL AVE #310
GLENDALE CA
91203-1821
US

IV. Provider business mailing address

633 N CENTRAL AVE #310
GLENDALE CA
91203-1821
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-0712
  • Fax: 818-553-1918
Mailing address:
  • Phone: 818-500-0712
  • Fax: 818-553-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA25620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA25620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: