Healthcare Provider Details

I. General information

NPI: 1376937524
Provider Name (Legal Business Name): KRIYA EMANUELLE GISHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S RODEO DR STE 200
BEVERLY HILLS CA
90212-2440
US

IV. Provider business mailing address

1016 NOWITA PL
VENICE CA
90291-3519
US

V. Phone/Fax

Practice location:
  • Phone: 310-890-7262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA171276
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA171276
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA171276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: