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NPI Code Detail

MEDICARE: PA OMAR CHAM LCSW

MEDICARE: PA OMAR CHAM LCSW
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
11041C0700XClinical Social Worker21951MD
21041C0700XClinical Social Worker106708CA

General Provider Information

NPI Number : 1730947888
Entity Type Code : Individual
Provider Name (Legal Business Name) : PA OMAR CHAM LCSW
Provider Business Mailing Address
First Line : 11301 WILSHIRE BOULEVARD
Second Line : BUILDING 500 ROOM 6251 M122
City : LOS ANGELES
State : CA
Zip : 90073
Country : US
Telephone Number : 310-478-3711
Fax Number :
Provider Business Practice Location Address
First Line : 11301 WILSHIRE BOULEVARD BUILDING 500
Second Line : ROOM 6251 M122
City : LOS ANGELES
State : CA
Zip : 90073
Country : US
Telephone Number : 310-478-3711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2024
Last Update Date : 03/12/2024

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