Provider Demographics
NPI:1003132127
Name:OHEB, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:OHEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 BALBOA BLVD STE 445
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2844
Mailing Address - Country:US
Mailing Address - Phone:818-946-8424
Mailing Address - Fax:818-946-8429
Practice Address - Street 1:5363 BALBOA BLVD STE 445
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2844
Practice Address - Country:US
Practice Address - Phone:818-946-8424
Practice Address - Fax:181-946-8429
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254820207X00000X
CAA128003207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB218588Medicare PIN