Healthcare Provider Details

I. General information

NPI: 1215940796
Provider Name (Legal Business Name): S. ADAM RAMIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 1407
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

12922 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-2924
US

V. Phone/Fax

Practice location:
  • Phone: 310-284-8191
  • Fax: 310-284-8113
Mailing address:
  • Phone: 818-760-2800
  • Fax: 818-760-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA60294
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA60294
License Number StateCA

VIII. Authorized Official

Name: DR. SOROUSH ADAM RAMIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-760-2800