=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720790512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBILE LIGHT MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2022
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1628 S GRAND AVE
-----------------------------------------------------
City | GLENDORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91740-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-996-0456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 S ALMONT DR
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-996-0456
-----------------------------------------------------
Fax | 980-217-2200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RAMIN RAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-996-0456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------