Provider Demographics
NPI:1699938225
Name:FIROUZ, SHAHROKH JIMMY (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHROKH
Middle Name:JIMMY
Last Name:FIROUZ
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 1:416 N BEDFORD DR STE 310
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4309
Mailing Address - Country:US
Mailing Address - Phone:310-274-4321
Mailing Address - Fax:
Practice Address - Street 1:416 N BEDFORD DR STE 310
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4309
Practice Address - Country:US
Practice Address - Phone:310-274-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82285208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery