Provider Demographics
NPI:1205863529
Name:BOGHOSSIAN, ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:BOGHOSSIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 BLACKHAWK PLAZA CIRCLE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506
Mailing Address - Country:US
Mailing Address - Phone:925-736-5959
Mailing Address - Fax:
Practice Address - Street 1:3380 BLACKHAWK PLAZA CIR STE 200
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4909
Practice Address - Country:US
Practice Address - Phone:925-736-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 8512207W00000X
KS05-31845207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology