Provider Demographics
NPI:1245285311
Name:BOGOSIAN, JEFFREY ARAM (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ARAM
Last Name:BOGOSIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5230 PACIFIC CONCOURSE DR
Mailing Address - Street 2:SUITE #110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6200
Mailing Address - Country:US
Mailing Address - Phone:310-643-0821
Mailing Address - Fax:310-643-7546
Practice Address - Street 1:5230 PACIFIC CONCOURSE DR
Practice Address - Street 2:SUITE #110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6200
Practice Address - Country:US
Practice Address - Phone:310-643-0821
Practice Address - Fax:310-643-7546
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG47831207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G478310Medicaid
CA00G478310Medicaid