1215940796 NPI number — S. ADAM RAMIN MD INC

Table of content: (NPI 1215940796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215940796 NPI number — S. ADAM RAMIN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S. ADAM RAMIN 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:
1215940796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12922 VICTORY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91606-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-760-2800
Provider Business Mailing Address Fax Number:
818-760-7343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 CENTURY PARK E
Provider Second Line Business Practice Location Address:
SUITE 1407
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90067-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-284-8191
Provider Business Practice Location Address Fax Number:
310-284-8113
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMIN
Authorized Official First Name:
SOROUSH
Authorized Official Middle Name:
ADAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-760-2800

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  A60294 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: A60294 , 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: 00A602941 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A602940 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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