Healthcare Provider Details

I. General information

NPI: 1679994420
Provider Name (Legal Business Name): ARNOLD MYOORAN MAHESAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR
BEVERLY HILLS CA
90210-4231
US

IV. Provider business mailing address

450 N ROXBURY DR STE 500
BEVERLY HILLS CA
90210-4226
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-2393
  • Fax:
Mailing address:
  • Phone: 310-277-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberC1-0027539
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberC196307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: