Healthcare Provider Details

I. General information

NPI: 1073721593
Provider Name (Legal Business Name): KHOSROW MEHRANY M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 TULLY RD STE 9
MODESTO CA
95350-4081
US

IV. Provider business mailing address

PO BOX 26310
SAN JOSE CA
95159-6310
US

V. Phone/Fax

Practice location:
  • Phone: 209-338-7758
  • Fax: 209-554-0311
Mailing address:
  • Phone: 408-335-3966
  • Fax: 408-292-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KHOSROW MEHRANY
Title or Position: OWNER DIRECTION MD
Credential: MD
Phone: 408-603-6366