Provider Demographics
NPI:1962619940
Name:UNIVERSITY FERTILITY LABORATORY INC.
Entity type:Organization
Organization Name:UNIVERSITY FERTILITY LABORATORY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-378-7445
Mailing Address - Street 1:23550 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4731
Mailing Address - Country:US
Mailing Address - Phone:310-378-7445
Mailing Address - Fax:310-378-7427
Practice Address - Street 1:23550 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4731
Practice Address - Country:US
Practice Address - Phone:310-378-7445
Practice Address - Fax:310-378-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty