Healthcare Provider Details

I. General information

NPI: 1366621914
Provider Name (Legal Business Name): SHAHRAM KHORSHIDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SHAWN KHORSHIDI MD

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 OBERLIN DR
SAN DIEGO CA
92121-1700
US

IV. Provider business mailing address

5405 OBERLIN DR
SAN DIEGO CA
92121-1700
US

V. Phone/Fax

Practice location:
  • Phone: 619-784-1314
  • Fax:
Mailing address:
  • Phone: 619-784-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: