Healthcare Provider Details

I. General information

NPI: 1568030708
Provider Name (Legal Business Name): JORDAN KAI SIMMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S LASKY DR
BEVERLY HILLS CA
90212-3610
US

IV. Provider business mailing address

201 S LASKY DR
BEVERLY HILLS CA
90212-3610
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-4572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberG187732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: