MEDICARE: SOM KOHANZADEH 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	208600000X	Surgery Physician	A95627	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A95627	CA

General Provider Information

NPI Number	:	1952575342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOM KOHANZADEH MD

Provider Business Mailing Address
First Line	:	9663 SANTA MONICA BLVD # 1151
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4303
Country	:	US
Telephone Number	:	310-919-4179
Fax Number	:	818-643-4255

Provider Business Practice Location Address
First Line	:	250 N ROBERTSON BLVD STE 106
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1767
Country	:	US
Telephone Number	:	310-919-4179
Fax Number	:	818-643-4255

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	07/06/2020

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Directions to “ SOM KOHANZADEH MD” Practice Location

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