Healthcare Provider Details

I. General information

NPI: 1801103114
Provider Name (Legal Business Name): OSHIN BOJALIAN, M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

633 N CENTRAL AVE STE 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

VIII. Authorized Official

Name: DR. OSHIN BOJALIAN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 818-500-0712