Provider Demographics
NPI:1043231442
Name:OBULJEN, FRANK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:EDWARD
Last Name:OBULJEN
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 1:18941 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-2839
Mailing Address - Country:US
Mailing Address - Phone:714-637-7988
Mailing Address - Fax:714-637-7988
Practice Address - Street 1:18941 VALLEY DR
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-2839
Practice Address - Country:US
Practice Address - Phone:714-637-7988
Practice Address - Fax:714-637-7988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE28955208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-25608Medicare UPIN
CAA-25608Medicare ID - Type Unspecified