Healthcare Provider Details

I. General information

NPI: 1306148796
Provider Name (Legal Business Name): KEIVAN GOLCHINI, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WILSHIRE BLVD SUITE 245
BEVERLY HILLS CA
90212-3401
US

IV. Provider business mailing address

9100 WILSHIRE BLVD SUITE 245
BEVERLY HILLS CA
90212-3401
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-7649
  • Fax:
Mailing address:
  • Phone: 310-276-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA48800
License Number StateCA

VIII. Authorized Official

Name: KEIVAN GOLCHINI
Title or Position: CEO
Credential: MD
Phone: 310-276-7649