Healthcare Provider Details

I. General information

NPI: 1124051172
Provider Name (Legal Business Name): BABAK AZIZZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

8670 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-2253
  • Fax: 310-657-0776
Mailing address:
  • Phone: 310-657-2253
  • Fax: 310-657-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA64794
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA64794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: