Provider Demographics
NPI:1639363039
Name:ASHKAN GHAVAMI, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ASHKAN GHAVAMI, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAVAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-855-2110
Mailing Address - Street 1:1797 ROYAL SAINT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4320
Mailing Address - Country:US
Mailing Address - Phone:310-855-2110
Mailing Address - Fax:310-887-4707
Practice Address - Street 1:433 N CAMDEN DR
Practice Address - Street 2:SUITE 780
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4409
Practice Address - Country:US
Practice Address - Phone:310-275-1959
Practice Address - Fax:310-887-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98255208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty