Healthcare Provider Details

I. General information

NPI: 1831242023
Provider Name (Legal Business Name): NICHOLAS R. NIKOLOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE. 207
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

436 N BEDFORD DR STE 207
BEVERLY HILLS CA
90210-4312
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-1932
  • Fax: 310-247-8140
Mailing address:
  • Phone: 310-247-1932
  • Fax: 310-247-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG78745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: