Healthcare Provider Details

I. General information

NPI: 1669064366
Provider Name (Legal Business Name): INLAND PHYSICIANS PULMONARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 N 13TH AVE
UPLAND CA
91786-4906
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 909-985-9321
  • Fax: 909-985-0842
Mailing address:
  • Phone: 909-626-1205
  • Fax: 909-625-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 2
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