Organization
KEIICHIRO OMORI MD
Active
Other names
KEIICHIRO OMORI MD
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
1801 W ROMNEYA DR STE 407, ANAHEIM, CA 92801-1827
(714) 533-3870
(714) 533-6714
Mailing address
1801 W ROMNEYA DR STE 407, ANAHEIM, CA 92801-1827
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A26248
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0558710
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
08/22/2020
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