Keiichiro Omori MD

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

A26248 Issued in CA

Legal business name

KEIICHIRO OMORI MD

Doing business as

Keiichiro Omori MD

Practice address

1801 W Romneya Dr Ste 407
Anaheim, CA 92801-1827

Phone

(714) 533-3870

Fax

(714) 533-6714

NPI assigned

Oct 23, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Direndia Shackelford

Title

Managed Care Specialist

Phone

(800) 654-0889

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• KEIICHIRO OMORI MD Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keiichiro Omori, MD

  • Pediatrics Physician
  • Anaheim, CA
  • NPI 1588752315
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821171158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W ROMNEYA DR STE 407",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W ROMNEYA DR STE 407",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011827",
            "telephone_number": "714-533-3870",
            "fax_number": "714-533-6714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEIICHIRO OMORI MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A26248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0558710",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KEIICHIRO OMORI MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin Michael Keegan
• Mary Kay Keehn, CNM
• Aminah Keftaro
• Charis Kehler
• Jennifer Tsoi Keihner, MD
• Kelly Keiser
• McKinna Keizer
• Cristina Sanchez Keller
• Charles A. Kellerman, MD
• Emily Dayne Kelly

• Non-Pharmacy Dispensing Site in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.