Healthcare Provider Details

I. General information

NPI: 1902960644
Provider Name (Legal Business Name): DAVID KHORRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503900 MOOTY 13 FISHERMEN BEACHROAD, GARAPAN
SAIPAN MP
96950-3900
US

IV. Provider business mailing address

PO BOX 503900
SAIPAN MP
96950-3900
US

V. Phone/Fax

Practice location:
  • Phone: 670-235-9090
  • Fax: 670-235-9091
Mailing address:
  • Phone: 670-235-9090
  • Fax: 670-235-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0102
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: