MEDICARE: DR. SOROUSH ADAM RAMIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	A60294	CA
2	208800000X	Urology Physician	A60294	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	954827961	OTHER	CA	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	201602227	OTHER	CA	TAX ID

General Provider Information

NPI Number	:	1639386626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOROUSH ADAM RAMIN M.D.

Provider Business Mailing Address
First Line	:	12922 VICTORY BLVD
Second Line	:	ASSUTA FAMILY MEDICAL GROUP APMC
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2924
Country	:	US
Telephone Number	:	818-760-2800
Fax Number	:	818-760-7343

Provider Business Practice Location Address
First Line	:	12922 VICTORY BLVD
Second Line	:	ASSUTA FAMILY MEDICAL GROUP APMC
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2924
Country	:	US
Telephone Number	:	818-760-2800
Fax Number	:	818-760-7343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	01/15/2022

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Directions to “ DR. SOROUSH ADAM RAMIN M.D.” Practice Location

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