Healthcare Provider Details

I. General information

NPI: 1346829603
Provider Name (Legal Business Name): OMEED GHASSEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 WOODLAKE AVE STE 270
WEST HILLS CA
91307-1470
US

IV. Provider business mailing address

7320 WOODLAKE AVE STE 270
WEST HILLS CA
91307-1470
US

V. Phone/Fax

Practice location:
  • Phone: 818-340-3822
  • Fax: 818-706-9857
Mailing address:
  • Phone: 818-340-3822
  • Fax: 818-706-9857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA200061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: