Healthcare Provider Details

I. General information

NPI: 1215457015
Provider Name (Legal Business Name): EHSAN AZIMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD STE 220
BEVERLY HILLS CA
90212-2110
US

IV. Provider business mailing address

9735 WILSHIRE BLVD STE 220
BEVERLY HILLS CA
90212-2110
US

V. Phone/Fax

Practice location:
  • Phone: 310-623-3200
  • Fax: 310-623-1800
Mailing address:
  • Phone: 310-623-3200
  • Fax: 310-623-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA172626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: