Healthcare Provider Details

I. General information

NPI: 1033175484
Provider Name (Legal Business Name): JOHN A. HOVANESIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/16/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA STE 300
LAGUNA HILLS CA
92653-3665
US

IV. Provider business mailing address

23961 CALLE DEL LA MAGDALENA SUITE 300
LAGUNA HILLS CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-2020
  • Fax: 949-951-9244
Mailing address:
  • Phone: 949-951-2020
  • Fax: 949-951-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG83665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: