Healthcare Provider Details

I. General information

NPI: 1326558669
Provider Name (Legal Business Name): KEYHAN PIRANVISEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2017
Last Update Date: 09/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

9350 CAMPUS POINT DR # 2-A
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 818-602-0098
  • Fax:
Mailing address:
  • Phone: 858-534-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: