Provider Demographics
NPI:1639386626
Name:RAMIN, SOROUSH ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SOROUSH
Middle Name:ADAM
Last Name:RAMIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12922 VICTORY BLVD
Mailing Address - Street 2:ASSUTA FAMILY MEDICAL GROUP APMC
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:ASSUTA FAMILY MEDICAL GROUP APMC
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
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-01-15
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Provider Licenses
StateLicense IDTaxonomies
CAA602942086X0206X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954827961OtherTAX ID
CA00A602940Medicaid
CA00W184600Medicaid
CA201602227OtherTAX ID
CA201602227OtherTAX ID
CA954827961OtherTAX ID
CAG90984Medicare UPIN
CAW18460Medicare ID - Type Unspecified
CA00W184600Medicaid