Healthcare Provider Details

I. General information

NPI: 1033507926
Provider Name (Legal Business Name): HAZANI MEDICAL CORPORATION APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ROBERTSON BLVD 208
BEVERLY HILLS CA
90211-1729
US

IV. Provider business mailing address

1245 S CAMDEN DR
LOS ANGELES CA
90035-1111
US

V. Phone/Fax

Practice location:
  • Phone: 410-494-6875
  • Fax: 310-388-0263
Mailing address:
  • Phone: 310-494-6875
  • Fax: 310-388-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YARON HAZANI
Title or Position: PRESIDENT/OWNER
Credential: M.D., FACS
Phone: 310-494-6875