Healthcare Provider Details

I. General information

NPI: 1194949180
Provider Name (Legal Business Name): BENJAMIN BEHROOZAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 W SUNSET BLVD
LOS ANGELES CA
90027-5716
US

IV. Provider business mailing address

5255 W SUNSET BLVD
LOS ANGELES CA
90027-5716
US

V. Phone/Fax

Practice location:
  • Phone: 323-463-7262
  • Fax:
Mailing address:
  • Phone: 323-463-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA41374
License Number StateCA

VIII. Authorized Official

Name: BENJAMIN BEHROOZAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-463-7262