Individual
MR. BABAK KHORRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
13330 BLOOMFIELD AVE, NORWALK, CA 90650-3251
(562) 868-0733
Mailing address
62 ROCKPORT, IRVINE, CA 92602-1050
(562) 868-0733
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA14508
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA14508
—
CA
Enumeration date
07/27/2006
Last updated
07/09/2007
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