Healthcare Provider Details

I. General information

NPI: 1184772014
Provider Name (Legal Business Name): REZA KHOSHINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 FROST ST SUITE 200
SAN DIEGO CA
92123-4205
US

IV. Provider business mailing address

8008 FROST ST SUITE 200
SAN DIEGO CA
92123-4205
US

V. Phone/Fax

Practice location:
  • Phone: 858-292-7527
  • Fax:
Mailing address:
  • Phone: 858-292-7527
  • Fax: 858-292-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA77202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA77202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: