Provider Demographics
NPI:1851395313
Name:IROMLOO, KHOSRO MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KHOSRO
Middle Name:MICHAEL
Last Name:IROMLOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:OBGYN DEPARTMENT
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-3082
Mailing Address - Fax:909-427-4536
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:KAISER FONTANA, OBGYN DEPT.
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-3082
Practice Address - Fax:909-427-4536
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI128174Medicare UPIN