Healthcare Provider Details

I. General information

NPI: 1770928459
Provider Name (Legal Business Name): KHAZ ANESTHESIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 WILBUR AVE SUITE 305
TARZANA CA
91356-1351
US

IV. Provider business mailing address

21241 VENTURA BLVD SUITE 158
WOODLAND HILLS CA
91364-2108
US

V. Phone/Fax

Practice location:
  • Phone: 818-578-5125
  • Fax:
Mailing address:
  • Phone: 818-884-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA85856
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA85856
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA85856
License Number StateCA

VIII. Authorized Official

Name: AMIR M KHAZAIELINAJAFABADI
Title or Position: PRESIDENT
Credential: MD
Phone: 916-266-1661