Provider Demographics
NPI:1972735074
Name:CHOWDHRY, OMAR S (DO)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:S
Last Name:CHOWDHRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W CIVIC CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4284
Mailing Address - Country:US
Mailing Address - Phone:888-854-3822
Mailing Address - Fax:770-701-6673
Practice Address - Street 1:1001 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3502
Practice Address - Country:US
Practice Address - Phone:714-953-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11561207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHH302ZMedicare PIN