Healthcare Provider Details

I. General information

NPI: 1679747307
Provider Name (Legal Business Name): HOOTAN ZANDIFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
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: 310-496-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number23151
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA109191
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number01064955A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: