Provider Demographics
NPI:1811280548
Name:KIBROM G ASRAT DPM APC
Entity type:Organization
Organization Name:KIBROM G ASRAT DPM APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIBROM
Authorized Official - Middle Name:GHIRMAY
Authorized Official - Last Name:ASRAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-868-0700
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90651-0321
Mailing Address - Country:US
Mailing Address - Phone:562-868-0700
Mailing Address - Fax:
Practice Address - Street 1:13132 STUDEBAKER RD STE 1
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2558
Practice Address - Country:US
Practice Address - Phone:562-868-0700
Practice Address - Fax:562-888-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4925213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty