1154743052 NPI number — RAMIN GHAYOORI MD,INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154743052 NPI number — RAMIN GHAYOORI MD,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMIN GHAYOORI MD,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154743052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91614-5020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-729-3606
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12626 RIVERSIDE DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91607-3448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-560-5189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GHAYOORI
Authorized Official First Name:
RAMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD/CHAIR
Authorized Official Telephone Number:
310-560-5189

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A104182 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1922297357 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922297357 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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