MEDICARE: DR. FARDAD FOROUZANPOUR D.O.

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	208600000X	Surgery Physician	20A7188	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	20A7188	CA

General Provider Information

NPI Number	:	1477673598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARDAD FOROUZANPOUR D.O.

Provider Business Mailing Address
First Line	:	8500 WILSHIRE BLVD STE 1020
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3108
Country	:	US
Telephone Number	:	310-360-0504
Fax Number	:	310-360-6246

Provider Business Practice Location Address
First Line	:	8500 WILSHIRE BLVD STE 1020
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3108
Country	:	US
Telephone Number	:	310-360-0504
Fax Number	:	310-360-6246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	09/11/2025

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