Healthcare Provider Details

I. General information

NPI: 1790943355
Provider Name (Legal Business Name): ROYA GHAFOURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD STE 421
BEVERLY HILLS CA
90212-2113
US

IV. Provider business mailing address

9735 WILSHIRE BLVD STE 421
BEVERLY HILLS CA
90212-2113
US

V. Phone/Fax

Practice location:
  • Phone: 310-990-0905
  • Fax: 424-204-1459
Mailing address:
  • Phone: 310-990-0905
  • Fax: 424-204-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberA115937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: