Healthcare Provider Details

I. General information

NPI: 1902676695
Provider Name (Legal Business Name): OHARA AIVAZ MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S BEVERLY DR STE 380
BEVERLY HILLS CA
90212-4424
US

IV. Provider business mailing address

802 S SPAULDING AVE
LOS ANGELES CA
90036-4608
US

V. Phone/Fax

Practice location:
  • Phone: 415-802-1310
  • Fax:
Mailing address:
  • Phone: 415-802-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OHARA AIVAZ
Title or Position: CEO
Credential: MD
Phone: 415-802-1310