Healthcare Provider Details

I. General information

NPI: 1508188913
Provider Name (Legal Business Name): BEVERLY HILLS SUNSET MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE M155
LOS ANGELES CA
90069-3701
US

IV. Provider business mailing address

PO BOX 15427
BEVERLY HILLS CA
90209-1427
US

V. Phone/Fax

Practice location:
  • Phone: 888-380-1899
  • Fax: 626-814-0915
Mailing address:
  • Phone: 888-380-1899
  • Fax: 626-814-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18539
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number301026
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number493968
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA72007
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG83471
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA25405
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA24640
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA61974
License Number StateCA

VIII. Authorized Official

Name: MR. NICK HOOMAN MASHOUR
Title or Position: PRESIDENT
Credential: MD
Phone: 888-380-1899