Healthcare Provider Details

I. General information

NPI: 1073651261
Provider Name (Legal Business Name): J TIMOTHY KATZEN MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD #407
BEVERLY HILLS CA
90212-2107
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD STE. 440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 310-471-5852
  • Fax: 310-471-3958
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG85745
License Number StateCA

VIII. Authorized Official

Name: JOHN TIMOTHY KATZEN
Title or Position: OWNER
Credential: M.D.
Phone: 310-859-7770