MEDICARE: DR. PHILIP HOM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	G51695	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740379668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP HOM M.D.

Provider Business Mailing Address
First Line	:	1245 WILSHIRE BLVD
Second Line	:	STE 616
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4806
Country	:	US
Telephone Number	:	213-484-1199
Fax Number	:	213-483-8211

Provider Business Practice Location Address
First Line	:	1245 WILSHIRE BLVD
Second Line	:	STE 616
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4806
Country	:	US
Telephone Number	:	310-968-2753
Fax Number	:	213-483-8211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/19/2020

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Directions to “ DR. PHILIP HOM M.D.” Practice Location

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