MEDICARE: MARINEH BOJALIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	43833	MN
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A100137	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871572826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINEH BOJALIAN M.D.

Provider Business Mailing Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:	BLDG 500, MAIL CODE 10H2
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:	BLDG 500, MAIL CODE 10H2
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	04/05/2016

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