Provider Demographics
NPI:1528078425
Name:OMARI, BASSAM (MD)
Entity type:Individual
Prefix:
First Name:BASSAM
Middle Name:
Last Name:OMARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 E IMPERIAL HWY
Mailing Address - Street 2:STE 502
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2661
Mailing Address - Country:US
Mailing Address - Phone:562-698-0271
Mailing Address - Fax:
Practice Address - Street 1:3680 E IMPERIAL HWY
Practice Address - Street 2:STE 502
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2661
Practice Address - Country:US
Practice Address - Phone:562-698-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43287208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A432870Medicaid
CAF09717Medicare UPIN
CA00A432870Medicaid
CAWA43287BMedicare PIN
CAWA43287DMedicare PIN