1821301714 NPI number — GASTROENTEROLOGY ASSOCIATES OF BEVERLY HILLS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821301714 NPI number — GASTROENTEROLOGY ASSOCIATES OF BEVERLY HILLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY ASSOCIATES OF BEVERLY HILLS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821301714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90067-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-273-7365
Provider Business Mailing Address Fax Number:
310-273-7366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9033 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-858-2224
Provider Business Practice Location Address Fax Number:
323-939-2439
Provider Enumeration Date:
07/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHAYE
Authorized Official First Name:
OMID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-858-2224

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A91773 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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