Provider Demographics
NPI:1831242023
Name:NIKOLOV, NICHOLAS R (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:R
Last Name:NIKOLOV
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 1:436 N BEDFORD DR STE 207
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4312
Mailing Address - Country:US
Mailing Address - Phone:310-247-1932
Mailing Address - Fax:310-247-8140
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:STE. 207
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-247-1932
Practice Address - Fax:310-247-8140
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78745208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG78745Medicare ID - Type Unspecified