Provider Demographics
NPI:1740379668
Name:HOM, PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:HOM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:STE 616
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4806
Mailing Address - Country:US
Mailing Address - Phone:213-484-1199
Mailing Address - Fax:213-483-8211
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:STE 616
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4806
Practice Address - Country:US
Practice Address - Phone:310-968-2753
Practice Address - Fax:213-483-8211
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG51695207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G516950Medicaid
CA00G516950Medicaid
CAE04639Medicare UPIN