MEDICARE: BEVERLY HILLS MEDICAL CORPORATION

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	208D00000X	General Practice Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010066259	OTHER	CA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ZZZ05665Z	OTHER	CA	BLUE SHIELD CA

General Provider Information

NPI Number	:	1740213222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	9808 VENICE BLVD
Second Line	:	SUITE 503
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6804
Country	:	US
Telephone Number	:	310-204-5510
Fax Number	:	310-204-5518

Provider Business Practice Location Address
First Line	:	9808 VENICE BLVD
Second Line	:	SUITE 503
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6804
Country	:	US
Telephone Number	:	310-204-5510
Fax Number	:	310-204-5518

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALI HADADZ
Credential	:	MD
Telephone Number	:	310-274-5510

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	09/19/2014

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Directions to “BEVERLY HILLS MEDICAL CORPORATION ” Practice Location

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