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NPI Code Detail

MEDICARE: EVAN GOLDSTEIN, D.O., INC., A PROFESSIONAL CORPORATION

MEDICARE: EVAN GOLDSTEIN, D.O., INC., A PROFESSIONAL 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
1208600000XSurgery Physician20A 14799CA

General Provider Information

NPI Number : 1780131011
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVAN GOLDSTEIN, D.O., INC., A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 9033 WILSHIRE BLVD STE 200
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-1836
Country : US
Telephone Number : 212-206-1501
Fax Number : 888-880-8621
Provider Business Practice Location Address
First Line : 9033 WILSHIRE BLVD STE 200
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-1836
Country : US
Telephone Number : 212-206-1501
Fax Number : 888-880-8621
Authorized Official
Title or Position : PRESIDENT
Name : EVAN GOLDSTEIN
Credential :
Telephone Number : 212-206-1501
Provider Enumeration Date : 09/02/2016
Last Update Date : 09/02/2016

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