Provider Demographics
NPI:1508188913
Name:BEVERLY HILLS SUNSET MEDICAL GROUP
Entity Type:Organization
Organization Name:BEVERLY HILLS SUNSET MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:HOOMAN
Authorized Official - Last Name:MASHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-380-1899
Mailing Address - Street 1:PO BOX 15427
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-1427
Mailing Address - Country:US
Mailing Address - Phone:888-380-1899
Mailing Address - Fax:626-814-0915
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:SUITE M155
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:888-380-1899
Practice Address - Fax:626-814-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301026163W00000X
CA493968163W00000X
CAA72007207R00000X
CAG83471207X00000X
CAA254052084N0400X
CAA246402084N0400X
CAA619742084N0400X
332B00000X
CAPA18539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty