Provider Demographics
NPI:1568636009
Name:J O MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:J O MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANESSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-292-8000
Mailing Address - Street 1:1325 EAST WINDSOR RD
Mailing Address - Street 2:4
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-6277
Mailing Address - Country:US
Mailing Address - Phone:818-292-8000
Mailing Address - Fax:818-507-6414
Practice Address - Street 1:13739 RIVESIDE DRIVE
Practice Address - Street 2:UNIT B
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2417
Practice Address - Country:US
Practice Address - Phone:818-292-8000
Practice Address - Fax:818-507-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty