Healthcare Provider Details

I. General information

NPI: 1891047478
Provider Name (Legal Business Name): TEHVAJAR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 RICHMOND HWY STE 120
ALEXANDRIA VA
22306-1849
US

IV. Provider business mailing address

6910 RICHMOND HWY STE 120
ALEXANDRIA VA
22306-1849
US

V. Phone/Fax

Practice location:
  • Phone: 202-494-0727
  • Fax:
Mailing address:
  • Phone: 202-494-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101249055
License Number StateVA

VIII. Authorized Official

Name: DR. KATAYOUN KHOSRAVANI
Title or Position: CEO/OWNER
Credential: MD
Phone: 202-494-0727