Healthcare Provider Details

I. General information

NPI: 1245610625
Provider Name (Legal Business Name): OMAR ZIAD YASIN MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLZ STE 660
LOS ANGELES CA
90024-6997
US

IV. Provider business mailing address

1331 MANHATTAN AVE APT B
HERMOSA BEACH CA
90254-3673
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6433
  • Fax:
Mailing address:
  • Phone: 330-322-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60968
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number60968
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number176128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: