Healthcare Provider Details

I. General information

NPI: 1235526450
Provider Name (Legal Business Name): HOOMAN NIKIZAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2015
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SAN PABLO ST STE 6200
LOS ANGELES CA
90033-5331
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-7920
  • Fax:
Mailing address:
  • Phone: 626-457-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA180206
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA180206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: