Healthcare Provider Details

I. General information

NPI: 1629075635
Provider Name (Legal Business Name): JOHN STEVEN OGHALAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/27/2023
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SAN PABLO ST STE 5100
LOS ANGELES CA
90033-4500
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5790
  • Fax:
Mailing address:
  • Phone: 323-442-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA75420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: