MEDICARE: DR. HOOTAN ZANDIFAR MD

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	207YS0123X	Facial Plastic Surgery Physician	A109191	CA
2	207Y00000X	Otolaryngology Physician	23151	ND
3	207YS0123X	Facial Plastic Surgery Physician	01064955A	IN

General Provider Information

NPI Number	:	1679747307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOOTAN ZANDIFAR MD

Provider Business Mailing Address
First Line	:	8920 WILSHIRE BLVD STE 604
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2006
Country	:	US
Telephone Number	:	310-736-4272
Fax Number	:	310-496-7235

Provider Business Practice Location Address
First Line	:	8920 WILSHIRE BLVD STE 604
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2006
Country	:	US
Telephone Number	:	310-736-4272
Fax Number	:	310-496-7235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	01/02/2026

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