Provider Demographics
NPI:1619084316
Name:UROLOGY CANCER SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:UROLOGY CANCER SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOROUSH
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:RAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-760-2800
Mailing Address - Street 1:12922 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2924
Mailing Address - Country:US
Mailing Address - Phone:818-760-2800
Mailing Address - Fax:818-760-7343
Practice Address - Street 1:12922 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2924
Practice Address - Country:US
Practice Address - Phone:818-760-2800
Practice Address - Fax:818-760-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA602942086X0206X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00W184600Medicaid
CA=========OtherEIN
CA00W184600Medicaid
CAG90984Medicare UPIN
CAW18460Medicare ID - Type Unspecified