Healthcare Provider Details

I. General information

NPI: 1609070218
Provider Name (Legal Business Name): DARYOUSH KHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAN KHANI M.D.

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 WILSHIRE BLVD STE 206
SANTA MONICA CA
90403-4946
US

IV. Provider business mailing address

2932 WILSHIRE BLVD STE 206
SANTA MONICA CA
90403-4946
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-7503
  • Fax: 310-453-9542
Mailing address:
  • Phone: 310-829-7503
  • Fax: 310-453-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA22000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: