Healthcare Provider Details

I. General information

NPI: 1104062272
Provider Name (Legal Business Name): JIMMY S. FIROUZ M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR 800
BEVERLY HILLS CA
90210-4206
US

IV. Provider business mailing address

465 N ROXBURY DR 800
BEVERLY HILLS CA
90210-4206
US

V. Phone/Fax

Practice location:
  • Phone: 310-867-3227
  • Fax:
Mailing address:
  • Phone: 310-867-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JIMMY S FIROUZ
Title or Position: FOUNDER/ CEO
Credential: MD
Phone: 310-867-3227