Healthcare Provider Details

I. General information

NPI: 1679733620
Provider Name (Legal Business Name): KAMBIZ GHAFOURIAN M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-2930
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 19-100
CHICAGO IL
60611-5969
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-8300
  • Fax:
Mailing address:
  • Phone: 312-664-3278
  • Fax: 312-695-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036138882
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036138882
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberA128170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: