Healthcare Provider Details

I. General information

NPI: 1073744975
Provider Name (Legal Business Name): BEVERLY HILLS PLASTIC SURGERY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD SUITE 302
BEVERLY HILLS CA
90210-5424
US

IV. Provider business mailing address

9301 WILSHIRE BLVD SUITE 302
BEVERLY HILLS CA
90210-5424
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-6600
  • Fax:
Mailing address:
  • Phone: 310-275-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA106786
License Number StateCA

VIII. Authorized Official

Name: DR. PAYMAN DANIELPOUR
Title or Position: CEO
Credential: MD
Phone: 310-275-6600