Healthcare Provider Details

I. General information

NPI: 1114417714
Provider Name (Legal Business Name): TANIA HASSANZADEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR STE 110
BEVERLY HILLS CA
90210-5016
US

IV. Provider business mailing address

436 N ROXBURY DR STE 110
BEVERLY HILLS CA
90210-5016
US

V. Phone/Fax

Practice location:
  • Phone: 310-362-6742
  • Fax: 310-362-6742
Mailing address:
  • Phone: 310-362-6742
  • Fax: 310-362-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA196731
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA196731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: