Provider Demographics
NPI:1477792901
Name:BEVERLY HILLS SPORTS MEDICINE GROUP, INC.
Entity Type:Organization
Organization Name:BEVERLY HILLS SPORTS MEDICINE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-1522
Mailing Address - Street 1:23852 PACIFIC COAST HWY
Mailing Address - Street 2:441
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4879
Mailing Address - Country:US
Mailing Address - Phone:310-828-1522
Mailing Address - Fax:
Practice Address - Street 1:9478 W OLYMPIC BLVD
Practice Address - Street 2:307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4246
Practice Address - Country:US
Practice Address - Phone:310-785-9123
Practice Address - Fax:206-202-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7818207R00000X
CAG29768208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty