Healthcare Provider Details

I. General information

NPI: 1356973572
Provider Name (Legal Business Name): HARTFORD PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR STE 117
BEVERLY HILLS CA
90210-5016
US

IV. Provider business mailing address

436 N ROXBURY DR STE 117
BEVERLY HILLS CA
90210-5016
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-9623
  • Fax: 310-385-8450
Mailing address:
  • Phone: 310-385-9623
  • Fax: 310-385-8450

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. VISHAL KAPOOR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-385-9623