Healthcare Provider Details

I. General information

NPI: 1316190457
Provider Name (Legal Business Name): RAMIN RAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W BROADWAY STE 100
GLENDALE CA
91204-1393
US

IV. Provider business mailing address

308 S ALMONT DR
BEVERLY HILLS CA
90211-3548
US

V. Phone/Fax

Practice location:
  • Phone: 818-545-7117
  • Fax: 818-545-8722
Mailing address:
  • Phone: 818-605-9795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA102239
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA102239
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA102239
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA102239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: