Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A64794 | CA |
NPI | 1124051172 |
---|---|
Provider Name | Babak Azizzadeh |
First Address | Beverly Hills, CA 90211 |
Second Address | Beverly Hills, CA 90211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A647940 | (05) | CA |
H94092 | (02) |