MEDICARE: KHOSROW DANESHVAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A48714	CA

General Provider Information

NPI Number	:	1982701645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHOSROW DANESHVAR M.D.

Provider Business Mailing Address
First Line	:	2409 S. VERMONT AVENUE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-1661
Country	:	US
Telephone Number	:	323-730-1663
Fax Number	:	323-730-9961

Provider Business Practice Location Address
First Line	:	530 E WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3723
Country	:	US
Telephone Number	:	213-747-2626
Fax Number	:	213-749-7500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	02/03/2017

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