Provider Demographics
NPI:1588234561
Name:BEVERLY HILLS MEDICAL INSTITUTE CORPORATION
Entity Type:Organization
Organization Name:BEVERLY HILLS MEDICAL INSTITUTE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAGHAYEGH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVASSOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-688-8080
Mailing Address - Street 1:621 N HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3514
Mailing Address - Country:US
Mailing Address - Phone:310-688-8080
Mailing Address - Fax:310-688-8081
Practice Address - Street 1:8635 W 3RD ST STE 865W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6140
Practice Address - Country:US
Practice Address - Phone:310-688-8080
Practice Address - Fax:310-688-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty