Provider Demographics
NPI:1649582826
Name:BAHMAN OMRANI DO INC
Entity type:Organization
Organization Name:BAHMAN OMRANI DO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMRANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-988-4088
Mailing Address - Street 1:4312 WOODMAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5515
Mailing Address - Country:US
Mailing Address - Phone:818-988-4088
Mailing Address - Fax:818-988-4018
Practice Address - Street 1:4312 WOODMAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5515
Practice Address - Country:US
Practice Address - Phone:818-988-4088
Practice Address - Fax:818-988-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9465207RA0401X, 207R00000X
261Q00000X, 261QM1300X, 174400000X, 261QR0405X, 261QU0200X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700945417OtherINDIVIDUAL NPI