Provider Demographics
NPI:1821301714
Name:GASTROENTEROLOGY ASSOCIATES OF BEVERLY HILLS
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF BEVERLY HILLS
Other - Org Name:BEVERLY HILLS GASTROENTEROLOGY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-858-2224
Mailing Address - Street 1:PO BOX 67189
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-0189
Mailing Address - Country:US
Mailing Address - Phone:310-273-7365
Mailing Address - Fax:310-273-7366
Practice Address - Street 1:9033 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1837
Practice Address - Country:US
Practice Address - Phone:310-858-2224
Practice Address - Fax:323-939-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91773207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty