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General NPI Number Information
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NPI Number | 1457764276
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Entity Type | Organization
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Legal Business Name | SOM K PLASTIC SURGERY PC
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 8635 W 3RD ST SUITE 880W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6101
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Country | US
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Telephone | 424-239-9743
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Fax |
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Provider Business Mailing Address
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Address Line | 8635 W 3RD ST SUITE 880W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6101
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Country | US
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Telephone | 424-239-9743
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SOM KOHANZADEH
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Credential | MD
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Telephone | 424-239-9743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A95627
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License Number State | CA
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