Healthcare Provider Details

I. General information

NPI: 1477058261
Provider Name (Legal Business Name): KEON MAHMOUD PARSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 305
BEVERLY HILLS CA
90211-2921
US

IV. Provider business mailing address

5739 DELCO AVE
WOODLAND HILLS CA
91367-5416
US

V. Phone/Fax

Practice location:
  • Phone: 310-772-2866
  • Fax:
Mailing address:
  • Phone: 818-635-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA195971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: