Healthcare Provider Details

I. General information

NPI: 1871524702
Provider Name (Legal Business Name): KHOSRO SADEGHANI MD. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD SUITE 304
ENCINO CA
91436-1914
US

IV. Provider business mailing address

16661 VENTURA BLVD SUITE 304
ENCINO CA
91436-1914
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-7546
  • Fax: 818-990-9442
Mailing address:
  • Phone: 818-990-7546
  • Fax: 818-990-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA49841
License Number StateCA

VIII. Authorized Official

Name: DR. KHOSRO SADEGHANI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-990-7546