Healthcare Provider Details

I. General information

NPI: 1174362818
Provider Name (Legal Business Name): WOUND CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD STE 104A
BEVERLY HILLS CA
90211-1767
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD # 1151
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-919-4179
  • Fax: 877-239-0994
Mailing address:
  • Phone: 103-919-4179
  • Fax: 877-239-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SOM KOHANZADEH
Title or Position: PRESIDENT
Credential: MD
Phone: 310-429-2257