Healthcare Provider Details

I. General information

NPI: 1336777366
Provider Name (Legal Business Name): HOVSEP OHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N STAR WAY
MODESTO CA
95356-9262
US

IV. Provider business mailing address

622 S COLUMBUS AVE
GLENDALE CA
91204-1920
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-1200
  • Fax:
Mailing address:
  • Phone: 184-147-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number4351046256
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA195285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: