Provider Demographics
NPI:1700945417
Name:OMRANI, BAHMAN (DO)
Entity type:Individual
Prefix:DR
First Name:BAHMAN
Middle Name:
Last Name:OMRANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9465208M00000X, 208VP0000X, 204D00000X, 207R00000X, 208D00000X, 202C00000X, 207RA0401X, 207Q00000X, 209800000X, 2084A0401X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX94650Medicaid
W20A9465AMedicare PIN