Provider Demographics
NPI:1447318043
Name:BOJALIAN, OSHIN (MD)
Entity type:Individual
Prefix:MR
First Name:OSHIN
Middle Name:
Last Name:BOJALIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSHIN
Other - Middle Name:
Other - Last Name:BOJALIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:633 N CENTRAL AVE
Mailing Address - Street 2:#310
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1821
Mailing Address - Country:US
Mailing Address - Phone:818-500-0712
Mailing Address - Fax:818-553-1918
Practice Address - Street 1:633 N CENTRAL AVE
Practice Address - Street 2:#310
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1821
Practice Address - Country:US
Practice Address - Phone:818-500-0712
Practice Address - Fax:818-553-1918
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25620207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A25620Medicare ID - Type Unspecified
C03851Medicare UPIN