Provider Demographics
NPI:1659464675
Name:LONG BEACH VA
Entity Type:Organization
Organization Name:LONG BEACH VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:MASOUD
Authorized Official - Last Name:KARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:565-826-8000
Mailing Address - Street 1:60 CORNFLOWER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3389
Mailing Address - Country:US
Mailing Address - Phone:714-390-0985
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-5853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82484261QA1903X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Not Answered282N00000XHospitalsGeneral Acute Care Hospital