Provider Demographics
NPI:1962421164
Name:OMIDI, JULIAN C (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:C
Last Name:OMIDI
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 1:10920 WILSHIER BLVD
Mailing Address - Street 2:SUITE #150-9161
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6502
Mailing Address - Country:US
Mailing Address - Phone:310-273-8885
Mailing Address - Fax:310-273-8662
Practice Address - Street 1:9001 WILSHER
Practice Address - Street 2:SUITE 106
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1839
Practice Address - Country:US
Practice Address - Phone:661-267-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71181207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA71181AMedicare ID - Type Unspecified
H22810Medicare UPIN