Healthcare Provider Details

I. General information

NPI: 1598999815
Provider Name (Legal Business Name): BEVERLY HILLS GASTROENTEROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 WILSHIRE BLVD SUITE 303
LOS ANGELES CA
90048-5123
US

IV. Provider business mailing address

6222 WILSHIRE BLVD SUITE 303
LOS ANGELES CA
90048-5123
US

V. Phone/Fax

Practice location:
  • Phone: 323-939-2442
  • Fax:
Mailing address:
  • Phone: 323-939-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. OMID A SHAYE
Title or Position: CEO
Credential: M.D.
Phone: 323-939-2442