Healthcare Provider Details

I. General information

NPI: 1992614739
Provider Name (Legal Business Name): ELHAM KHEIRKHAHI DDS MSD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE 402
RANCHO MIRAGE CA
92270-4149
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR STE 402
RANCHO MIRAGE CA
92270-4149
US

V. Phone/Fax

Practice location:
  • Phone: 760-836-1809
  • Fax:
Mailing address:
  • Phone: 760-836-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MICHAELA MUNIZ
Title or Position: VP, PAYOR RELATIONS
Credential:
Phone: 469-324-3242