Provider Demographics
NPI:1336187343
Name:LAMPORT, INNA (MD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:LAMPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8306 WILSHIRE BLVD
Mailing Address - Street 2:#501
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2382
Mailing Address - Country:US
Mailing Address - Phone:310-613-2414
Mailing Address - Fax:805-494-8379
Practice Address - Street 1:1211 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3507
Practice Address - Country:US
Practice Address - Phone:323-258-3060
Practice Address - Fax:323-258-1040
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50462207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A504621Medicaid
CA00A504621Medicaid
CAF51351Medicare UPIN