=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801439716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROX PHYSICIAN MEDICAL GROUP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2019
-----------------------------------------------------
Last Update Date | 10/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 436 N ROXBURY DR STE 207
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-5017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-529-9237
-----------------------------------------------------
Fax | 626-331-3204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 436 N ROXBURY DR STE 207
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-5017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-529-9237
-----------------------------------------------------
Fax | 626-331-3204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | A.J. KHALIL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-385-8601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------