Provider Demographics
NPI:1326932682
Name:EHSAN AZIMI MD DERMATOLOGY CORP
Entity type:Organization
Organization Name:EHSAN AZIMI MD DERMATOLOGY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-268-3154
Mailing Address - Street 1:9735 WILSHIRE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2110
Mailing Address - Country:US
Mailing Address - Phone:703-268-3154
Mailing Address - Fax:
Practice Address - Street 1:9735 WILSHIRE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2110
Practice Address - Country:US
Practice Address - Phone:703-268-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization