Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G83665 | CA |
NPI | 1033175484 |
---|---|
Provider Name | John A. Hovanesian |
First Address | Laguna Hills, CA 92653-3623 |
Second Address | Laguna Hills, CA 92653-3623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G35937 | (02) | CA |