Healthcare Provider Details

I. General information

NPI: 1679215255
Provider Name (Legal Business Name): JIVAN HOVSEPYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 E COLORADO BLVD STE B
PASADENA CA
91107-3972
US

IV. Provider business mailing address

3768 E COLORADO BLVD STE B
PASADENA CA
91107-3972
US

V. Phone/Fax

Practice location:
  • Phone: 626-345-5279
  • Fax: 626-345-5293
Mailing address:
  • Phone: 626-345-5279
  • Fax: 626-345-5293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: