Basic Information
| Provider Information | |||||||||
| NPI: | 1952321176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORN | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MEDICAL PLAZA | ||||||||
| Address2: | 370 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108252448 | ||||||||
| FaxNumber: | 3102067866 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MEDICAL PLAZA | ||||||||
| Address2: | #365,530,420,120 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107949718 | ||||||||
| FaxNumber: | 3107949718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | A63295 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 00A632950 | 05 | CA | MEDICAID |