MEDICARE: BEVERLY HILLS DOCTORS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A82527	CA

General Provider Information

NPI Number	:	1447708631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS DOCTORS, INC

Provider Business Mailing Address
First Line	:	269 S BEVERLY DR
Second Line	:	SUITE 1350
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9231 W OLYMPIC BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4658
Country	:	US
Telephone Number	:	310-709-7355
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAHROUZ GHODSIAN
Credential	:	MD
Telephone Number	:	310-709-7355

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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