Provider Demographics
NPI:1275563207
Name:KHORRAMI, PAYMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAYMAN
Middle Name:
Last Name:KHORRAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE 1804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2021
Mailing Address - Country:US
Mailing Address - Phone:310-553-5588
Mailing Address - Fax:310-553-5590
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE 1804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2021
Practice Address - Country:US
Practice Address - Phone:310-553-5588
Practice Address - Fax:310-553-5590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73031207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G730310Medicaid
CA100009555OtherMEDICARE RAILROAD
CA00G730310Medicaid
CA100009555OtherMEDICARE RAILROAD