Healthcare Provider Details

I. General information

NPI: 1932285566
Provider Name (Legal Business Name): MOHAMMAD RYAN KHOSRAVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N LA CIENEGA BLVD SUITE 216
BEVERLY HILLS CA
90211-2227
US

IV. Provider business mailing address

50 N LA CIENEGA BLVD SUITE 216
BEVERLY HILLS CA
90211-2227
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-9650
  • Fax:
Mailing address:
  • Phone: 310-247-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA84229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: