Healthcare Provider Details

I. General information

NPI: 1255465670
Provider Name (Legal Business Name): DR. AFSHIN FARZADMEHR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S BEVERLY DR STE 600
LOS ANGELES CA
90035-1182
US

IV. Provider business mailing address

609 N CAMDEN DR
BEVERLY HILLS CA
90210-3203
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-1133
  • Fax: 310-277-0630
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA69982
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA69982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: