MEDICARE: EHSAN AZIMI MD DERMATOLOGY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1326932682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EHSAN AZIMI MD DERMATOLOGY CORP

Provider Business Mailing Address
First Line	:	9735 WILSHIRE BLVD STE 220
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2110
Country	:	US
Telephone Number	:	703-268-3154
Fax Number	:

Provider Business Practice Location Address
First Line	:	9735 WILSHIRE BLVD STE 220
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2110
Country	:	US
Telephone Number	:	703-268-3154
Fax Number	:

Authorized Official
Title or Position	:	MD/PRACTICE OWNER
Name	:	DR. EHSAN AZIMI
Credential	:	MD
Telephone Number	:	703-268-3154

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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