Provider Demographics
NPI:1477058261
Name:PARSA, KEON MAHMOUD (MD)
Entity type:Individual
Prefix:
First Name:KEON
Middle Name:MAHMOUD
Last Name:PARSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5739 DELCO AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5416
Mailing Address - Country:US
Mailing Address - Phone:818-635-4450
Mailing Address - Fax:
Practice Address - Street 1:8641 WILSHIRE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2921
Practice Address - Country:US
Practice Address - Phone:310-772-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1959712082S0099X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program