Healthcare Provider Details

I. General information

NPI: 1255128831
Provider Name (Legal Business Name): DANIEL KARL OBERMILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 E 3RD ST
LOS ANGELES CA
90022-1602
US

IV. Provider business mailing address

4816 E 3RD ST
LOS ANGELES CA
90022-1602
US

V. Phone/Fax

Practice location:
  • Phone: 323-780-4510
  • Fax:
Mailing address:
  • Phone: 323-780-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1740835743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: