# KEIICHIRO OMORI MD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KEIICHIRO OMORI MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821171158
- **Authorized official:** DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
- **Authorized official phone:** (800) 654-0889

## Contact information

- **Practice address:** 1801 W ROMNEYA DR STE 407, ANAHEIM, CA 92801-1827
- **Practice address phone:** (714) 533-3870
- **Practice address fax:** (714) 533-6714
- **Mailing address:** 1801 W ROMNEYA DR STE 407, ANAHEIM, CA 92801-1827

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A26248 | CA | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 08/22/2020