Healthcare Provider Details

I. General information

NPI: 1639979602
Provider Name (Legal Business Name): DERMATOLOGY AND HAIR RESTORATION SPECIALISTS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11669 SANTA MONICA BLVD STE 110
LOS ANGELES CA
90025-2929
US

IV. Provider business mailing address

11669 SANTA MONICA BLVD STE 110
LOS ANGELES CA
90025-2929
US

V. Phone/Fax

Practice location:
  • Phone: 310-315-4989
  • Fax: 310-998-3282
Mailing address:
  • Phone: 310-315-4989
  • Fax: 310-998-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BEN E BEHNAM
Title or Position: DIRECTOR
Credential: MD
Phone: 310-315-4989