Healthcare Provider Details

I. General information

NPI: 1972735074
Provider Name (Legal Business Name): OMAR S CHOWDHRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2009
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N TUSTIN AVE
SANTA ANA CA
92705-3502
US

IV. Provider business mailing address

150 W CIVIC CENTER DR STE 200
SANDY UT
84070-4284
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-3500
  • Fax:
Mailing address:
  • Phone: 888-854-3822
  • Fax: 770-701-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A11561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: