Provider Demographics
NPI:1053322719
Name:FIROOZMAND, EIMAN (MD)
Entity Type:Individual
Prefix:
First Name:EIMAN
Middle Name:
Last Name:FIROOZMAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4703
Mailing Address - Country:US
Mailing Address - Phone:310-273-2310
Mailing Address - Fax:310-273-0314
Practice Address - Street 1:9400 BRIGHTON WAY
Practice Address - Street 2:SUITE 307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4703
Practice Address - Country:US
Practice Address - Phone:310-273-2310
Practice Address - Fax:310-273-0314
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65759208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1002337OtherCLIA NO
CA352174655OtherFEDERAL TAX ID
CA352174655OtherFEDERAL TAX ID
CAA65759Medicare PIN