MEDICARE: ADVANCED MEDICAL & SURGICAL VENTURES CORPORATION

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	207RC0000X	Cardiovascular Disease Physician		CA

General Provider Information

NPI Number	:	1972030427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL & SURGICAL VENTURES CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 16758
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 S GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1713
Country	:	US
Telephone Number	:	818-547-6000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HOMAYOUN SHARIM
Credential	:	MD
Telephone Number	:	310-625-6642

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	11/10/2020

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