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General NPI Number Information
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NPI Number | 1598999815
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS GASTROENTEROLOGY ASSOCIATES
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 6222 WILSHIRE BLVD SUITE 303
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City | LOS ANGELES
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State | CA
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Zip | 90048-5123
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Country | US
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Telephone | 323-939-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 6222 WILSHIRE BLVD SUITE 303
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City | LOS ANGELES
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State | CA
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Zip | 90048-5123
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Country | US
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Telephone | 323-939-2442
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. OMID A SHAYE
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Credential | M.D.
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Telephone | 323-939-2442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | CA
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