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
1	1041C0700X	Clinical Social Worker	21951	MD
2	1041C0700X	Clinical Social Worker	106708	CA

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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Directions to “ PA OMAR CHAM LCSW” Practice Location

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