MEDICARE: BEVERLY HILLS HEAD AND NECK GROUP

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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician

General Provider Information

NPI Number	:	1851800486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS HEAD AND NECK GROUP

Provider Business Mailing Address
First Line	:	9401 WILSHIRE BLVD STE 650
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 WILSHIRE BLVD STE 650
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2913
Country	:	US
Telephone Number	:	631-827-8159
Fax Number	:

Authorized Official
Title or Position	:	PATIENT ACCOUNTS
Name	:	MATHEW JAMES
Credential	:
Telephone Number	:	631-827-8159

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	09/27/2017

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