Provider Demographics
NPI:1164694212
Name:OULASHIAN, MIKE (MD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:OULASHIAN
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:
Practice Address - Street 1:248 HAMPSHIRE RD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-2401
Practice Address - Country:US
Practice Address - Phone:805-370-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2024-02-01
Deactivation Date:2013-06-12
Deactivation Code:
Reactivation Date:2013-08-22
Provider Licenses
StateLicense IDTaxonomies
CAA112776207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine