Provider Demographics
NPI:1740213222
Name:BEVERLY HILLS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BEVERLY HILLS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:HADADZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-5510
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6804
Mailing Address - Country:US
Mailing Address - Phone:310-204-5510
Mailing Address - Fax:310-204-5518
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 503
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6804
Practice Address - Country:US
Practice Address - Phone:310-204-5510
Practice Address - Fax:310-204-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA010066259OtherMEDICARE RAILROAD
CA00A698160Medicaid
CAZZZ05665ZOtherBLUE SHIELD CA
CA00A698160Medicaid
CAZZZ05665ZOtherBLUE SHIELD CA