Healthcare Provider Details

I. General information

NPI: 1760544639
Provider Name (Legal Business Name): DANIEL BEHROOZAN MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 LINCOLN BLVD #100
SANTA MONICA CA
90405-1320
US

IV. Provider business mailing address

2221 LINCOLN BLVD #100
SANTA MONICA CA
90405-1320
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-1111
  • Fax: 310-392-1101
Mailing address:
  • Phone: 310-392-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA76756
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA76756
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA76756
License Number StateCA

VIII. Authorized Official

Name: DR. DANIEL BEHROOZAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-392-1111