Provider Demographics
NPI:1063447530
Name:EDWIN OGHOORIAN, DPM, INC.
Entity Type:Organization
Organization Name:EDWIN OGHOORIAN, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGHOORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-914-4099
Mailing Address - Street 1:210 S GRAND AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4205
Mailing Address - Country:US
Mailing Address - Phone:626-914-4099
Mailing Address - Fax:626-914-4119
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4205
Practice Address - Country:US
Practice Address - Phone:626-914-4099
Practice Address - Fax:626-914-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4526213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45260Medicaid
ZZZ06981ZOtherMEDICARE ID
5281120001Medicare NSC
ZZZ06981ZOtherMEDICARE ID
V00838Medicare UPIN