Healthcare Provider Details

I. General information

NPI: 1407485493
Provider Name (Legal Business Name): GUPTA ZANDIFAR OPERATING ACCOUNT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 604
BEVERLY HILLS CA
90211-2006
US

IV. Provider business mailing address

8920 WILSHIRE BLVD STE 604
BEVERLY HILLS CA
90211-2006
US

V. Phone/Fax

Practice location:
  • Phone: 310-736-4272
  • Fax: 310-496-7235
Mailing address:
  • Phone: 310-736-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOOTAN ZANDIFAR
Title or Position: PARTNER
Credential: MD
Phone: 310-736-4272