Healthcare Provider Details

I. General information

NPI: 1821924606
Provider Name (Legal Business Name): SEPEHR TALEBUIAN KHORASANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E RED BRIDGE RD STE 105
KANSAS CITY MO
64131-4029
US

IV. Provider business mailing address

400 E RED BRIDGE RD STE 105
KANSAS CITY MO
64131-4029
US

V. Phone/Fax

Practice location:
  • Phone: 816-214-5548
  • Fax:
Mailing address:
  • Phone: 816-214-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026024179
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: