Provider Demographics
NPI:1275244378
Name:KAMERON REZZADEH MD PC INC
Entity Type:Organization
Organization Name:KAMERON REZZADEH MD PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:REZZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-275-6600
Mailing Address - Street 1:1385 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1419
Mailing Address - Country:US
Mailing Address - Phone:201-390-8121
Mailing Address - Fax:
Practice Address - Street 1:436 N BEDFORD DR STE 214
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4312
Practice Address - Country:US
Practice Address - Phone:310-275-6600
Practice Address - Fax:310-275-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty