Provider Demographics
NPI:1326041054
Name:OURIAN, SIMON S (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:S
Last Name:OURIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIAMAK
Other - Middle Name:
Other - Last Name:OURIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:444 N CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4507
Mailing Address - Country:US
Mailing Address - Phone:310-271-6506
Mailing Address - Fax:310-271-3786
Practice Address - Street 1:444 N CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4507
Practice Address - Country:US
Practice Address - Phone:310-271-6506
Practice Address - Fax:310-271-3786
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-26
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65201208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA65201AMedicare ID - Type Unspecified