Healthcare Provider Details

I. General information

NPI: 1467717975
Provider Name (Legal Business Name): MEHRAS AKHAVAN, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 09/02/2025
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 VAN NUYS BLVD STE 105
SHERMAN OAKS CA
91403-1740
US

IV. Provider business mailing address

4940 VAN NUYS BLVD STE 301
SHERMAN OAKS CA
91403-1700
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-9050
  • Fax: 818-990-9070
Mailing address:
  • Phone: 818-990-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License NumberA82275
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA82275
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA82275
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA82275
License Number StateCA

VIII. Authorized Official

Name: MEHRAS AKHAVAN
Title or Position: CEO
Credential: MD
Phone: 818-990-9050