Healthcare Provider Details

I. General information

NPI: 1669771184
Provider Name (Legal Business Name): SAMUEL GOLPANIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD
BEVERLY HILLS CA
90211-1938
US

IV. Provider business mailing address

8 CHERRY LN
KINGS POINT NY
11024-1122
US

V. Phone/Fax

Practice location:
  • Phone: 424-383-8111
  • Fax:
Mailing address:
  • Phone: 516-829-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA174591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: