Provider Demographics
NPI:1285684449
Name:OHANIAN, KIRK L (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:L
Last Name:OHANIAN
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:PO BOX 14005
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-1405
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:431 S BATAVIA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3936
Practice Address - Country:US
Practice Address - Phone:714-538-6731
Practice Address - Fax:714-771-8369
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG793442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G793440159OtherCALOPTIMA
CA00G793440OtherBLUE SHIELD
CA00G793440Medicaid
CA00G793441Medicare PIN
WG79344OMedicare PIN
CAP00174791Medicare PIN
P00082778Medicare PIN
G48249Medicare UPIN
CA00G793440Medicaid
WG79344MMedicare PIN
WG79344LMedicare PIN
CAWG79344KMedicare PIN