Healthcare Provider Details

I. General information

NPI: 1588555262
Provider Name (Legal Business Name): BEDFORD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N, BEDORG DR STE 205
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

436 N, BEDORG DR STE 205
BEVERLY HILLS CA
90210-4310
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-1932
  • Fax:
Mailing address:
  • Phone: 310-247-1932
  • 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: NICHOLAS NIKOLOV
Title or Position: PRESIDENT
Credential: MD
Phone: 310-247-1932