Healthcare Provider Details

I. General information

NPI: 1073632261
Provider Name (Legal Business Name): INLAND PULMONARY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 MONTE VISTA AVE STE 105
MONTCLAIR CA
91763-2231
US

IV. Provider business mailing address

9525 MONTE VISTA AVE # 105
MONTCLAIR CA
91763-2231
US

V. Phone/Fax

Practice location:
  • Phone: 909-626-1205
  • Fax: 909-670-0473
Mailing address:
  • Phone: 909-626-1205
  • Fax: 909-625-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAHRAM KHORRAMI
Title or Position: PARTNER
Credential: MD
Phone: 909-626-1205