Provider Demographics
NPI:1952321176
Name:GORN, ALAN HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:HOWARD
Last Name:GORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 MEDICAL PLAZA
Mailing Address - Street 2:370
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:310-825-2448
Mailing Address - Fax:310-206-7866
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#365,530,420,120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-794-9718
Practice Address - Fax:310-794-9718
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA63295207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A632950Medicaid
CAG00978Medicare UPIN
CAWA63295AMedicare PIN
CA00A632950Medicaid