Healthcare Provider Details

I. General information

NPI: 1275709040
Provider Name (Legal Business Name): BEHRAD AYNEHCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE 504
CULVER CITY CA
90232-2751
US

IV. Provider business mailing address

3831 HUGHES AVE 504
CULVER CITY CA
90232-2751
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-4111
  • Fax: 310-204-4474
Mailing address:
  • Phone: 310-204-4111
  • Fax: 310-204-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA124863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: