Provider Demographics
NPI:1629037213
Name:KUSUM M OHRI, MD INC.
Entity Type:Organization
Organization Name:KUSUM M OHRI, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KUSUM
Authorized Official - Middle Name:M
Authorized Official - Last Name:OHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-0414
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3857
Mailing Address - Country:US
Mailing Address - Phone:714-639-0414
Mailing Address - Fax:714-639-3313
Practice Address - Street 1:1310 W. STEWART DR.
Practice Address - Street 2:SUITE 602
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3857
Practice Address - Country:US
Practice Address - Phone:714-639-0414
Practice Address - Fax:714-639-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 44218207R00000X
CAA44218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ56075YOtherBLUE SHIELD OF CALIFORNIA
CA00A442180Medicaid
CAE43888Medicare UPIN
CAZZZ56075YOtherBLUE SHIELD OF CALIFORNIA
W21370Medicare PIN