Provider Demographics
NPI:1073632261
Name:INLAND PULMONARY MEDICAL GROUP
Entity Type:Organization
Organization Name:INLAND PULMONARY MEDICAL GROUP
Other - Org Name:INLAND PHYSICIANS MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORRAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-626-1205
Mailing Address - Street 1:9525 MONTE VISTA AVE # 105
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2231
Mailing Address - Country:US
Mailing Address - Phone:909-626-1205
Mailing Address - Fax:909-625-1977
Practice Address - Street 1:9525 MONTE VISTA AVE STE 105
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2231
Practice Address - Country:US
Practice Address - Phone:909-626-1205
Practice Address - Fax:909-670-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085860Medicaid
CAZZZ16631ZMedicare PIN
CAZZZ28638ZMedicare PIN
CAW15547Medicare PIN