Healthcare Provider Details

I. General information

NPI: 1558472589
Provider Name (Legal Business Name): MEHRAN J KHORSANDI, M.D.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE# 695W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST STE# 695W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-2140
  • Fax:
Mailing address:
  • Phone: 310-967-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG61809
License Number StateCA

VIII. Authorized Official

Name: DR. MEHRAN J KHORSANDI
Title or Position: PHYSICIAN
Credential: M.D.,
Phone: 310-967-2140