Provider Demographics
NPI:1952350993
Name:WESTSIDE RADIATION ONCOLOGY MEDICAL GROUP INC
Entity type:Organization
Organization Name:WESTSIDE RADIATION ONCOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BEHROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-423-4207
Mailing Address - Street 1:FILE 51000
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:310-423-4207
Mailing Address - Fax:310-659-3332
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:RM AC 1020
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-4207
Practice Address - Fax:310-659-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09138ZOtherBLUE SHIELD PIN
CAGR0100340Medicaid
CA=========OtherBLUE CROSS PIN
CAGR0100340Medicaid