Healthcare Provider Details

I. General information

NPI: 1720041858
Provider Name (Legal Business Name): OMID KHORRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23550 HAWTHORNE BLVD STE. 210
TORRANCE CA
90505-4731
US

IV. Provider business mailing address

23550 HAWTHORNE BLVD STE. 210
TORRANCE CA
90505-4731
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-7445
  • Fax: 310-378-7427
Mailing address:
  • Phone: 310-378-7445
  • Fax: 310-378-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA48465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: