Provider Demographics
NPI:1417780420
Name:SKULL BASE SURGERY INSTITUTE PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SKULL BASE SURGERY INSTITUTE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-355-0175
Mailing Address - Street 1:2080 CENTURY PARK E STE 1700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2020
Mailing Address - Country:US
Mailing Address - Phone:424-355-0175
Mailing Address - Fax:213-672-5093
Practice Address - Street 1:2080 CENTURY PARK E STE 1700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2020
Practice Address - Country:US
Practice Address - Phone:424-355-0175
Practice Address - Fax:213-672-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty