Healthcare Provider Details

I. General information

NPI: 1548143720
Provider Name (Legal Business Name): KIAN MEHRARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 ALAMO ST
SIMI VALLEY CA
93063-1733
US

IV. Provider business mailing address

6355 DE SOTO AVE APT B412
WOODLAND HILLS CA
91367-2639
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-3120
  • Fax:
Mailing address:
  • Phone: 818-300-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: