Brent R.W. Moelleken, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

G059781 Issued in CA

Practice address

120 S Spalding Dr Ste 340
Beverly Hills, CA 90212-1841

Phone

(310) 273-1001

Fax

(310) 205-4881

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: bmoelleken43232@direct.uclahealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neo Surgery Center Inc

  • Ambulatory Surgical Clinic/Center
  • Beverly Hills, CA
  • NPI 1457666885
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1851472534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 S PLYMOUTH BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900204709",
            "telephone_number": "310-273-1001",
            "fax_number": "310-205-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S SPALDING DR STE 340",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902121841",
            "telephone_number": "310-273-1001",
            "fax_number": "310-205-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOELLEKEN",
        "first_name": "BRENT",
        "middle_name": "R.W.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "G059781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modern Institue of Surgery, Inc
• Modern Institute of Plastic Surgery & Antiaging, Inc.
• Modern Intitute of Plastic Surgery & Anti-Aging
• Modern Surgery Centers LLC
• Michael Modica, M.D.
• Farshad Moftakhar, D.D.S.
• Liyan Moghadam Massaband, D.M.D.
• Christina Asal Moghadam, OD
• Guity Moghadam, MD
• Ehab Aly Mohamed, M.D.

• Plastic Surgery Physician in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.