Healthcare Provider Details

I. General information

NPI: 1457557100
Provider Name (Legal Business Name): BABAK RAZAGHI KHAMSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 RIVER CREST DR
RIVERSIDE CA
92507-0783
US

IV. Provider business mailing address

6276 RIVER CREST DR
RIVERSIDE CA
92507-0783
US

V. Phone/Fax

Practice location:
  • Phone: 951-413-0200
  • Fax: 951-653-5680
Mailing address:
  • Phone: 951-413-0200
  • Fax: 951-653-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA119808
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA119808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: