Healthcare Provider Details

I. General information

NPI: 1881987832
Provider Name (Legal Business Name): OMAR NOMAAN HUSSAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90211-1928
US

IV. Provider business mailing address

8907 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90211-1928
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-2111
  • Fax: 310-820-1368
Mailing address:
  • Phone: 310-820-2111
  • Fax: 310-820-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA116233
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA116233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: