Healthcare Provider Details

I. General information

NPI: 1932464641
Provider Name (Legal Business Name): SAHAND GOLSHAN-KHALILI D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4843 ARLINGTON AVE
RIVERSIDE CA
92504-2760
US

IV. Provider business mailing address

280 S LEMON AVE UNIT 210
WALNUT CA
91788-2608
US

V. Phone/Fax

Practice location:
  • Phone: 951-405-8500
  • Fax: 951-405-8555
Mailing address:
  • Phone: 951-405-8500
  • Fax: 951-405-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: