Idom Industries Inc.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

193471 Issued in CA

Legal business name

IDOM INDUSTRIES INC.

Practice address

171 N la Brea Ave Ste 204
Inglewood, CA 90301-1246

Phone

(310) 671-0023

Fax

(310) 419-9409

NPI assigned

Jul 18, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Byron Keith Idom Sr.

Title

Ceo

Phone

(310) 671-0023

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368057600000",
    "number": "1477808293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 N LA BREA AVE STE 204",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011246",
            "telephone_number": "310-671-0023",
            "fax_number": "310-419-9409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 N LA BREA AVE STE 204",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011246",
            "telephone_number": "310-671-0023",
            "fax_number": "310-419-9409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDOM INDUSTRIES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-18",
        "last_updated": "2013-05-09",
        "status": "A",
        "authorized_official_last_name": "IDOM",
        "authorized_official_first_name": "BYRON",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-671-0023",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "193471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Inglewood, CA
• Providers in Inglewood, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.