Healthcare Provider Details

I. General information

NPI: 1912796954
Provider Name (Legal Business Name): XYZ HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 MONTANA AVE
SANTA MONICA CA
90403-1808
US

IV. Provider business mailing address

1626 MONTANA AVE
SANTA MONICA CA
90403-1808
US

V. Phone/Fax

Practice location:
  • Phone: 310-974-8767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI GOLSHAN
Title or Position: OWNER
Credential: MD
Phone: 916-342-6460