Healthcare Provider Details

I. General information

NPI: 1740194745
Provider Name (Legal Business Name): KOROSH BORHANI D.O., PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11014 MONOGRAM AVE
GRANADA HILLS CA
91344-5216
US

IV. Provider business mailing address

22287 MULHOLLAND HWY # 370
CALABASAS CA
91302-5157
US

V. Phone/Fax

Practice location:
  • Phone: 747-367-0241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KOROSH BORHANI
Title or Position: PRESIDENT
Credential: DO
Phone: 818-900-2959