Healthcare Provider Details

I. General information

NPI: 1831393388
Provider Name (Legal Business Name): ASHKAN GHAVAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CAMDEN DR SUITE 780
BEVERLY HILLS CA
90210-4409
US

IV. Provider business mailing address

433 N CAMDEN DR SUITE 780
BEVERLY HILLS CA
90210-4409
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-2110
  • Fax: 310-877-4705
Mailing address:
  • Phone: 310-855-2110
  • Fax: 310-877-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA98255
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA98255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: