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General NPI Number Information
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NPI Number | 1124229554
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Entity Type | Organization
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Legal Business Name | KHOSROW MAHDAVI, M.D., INC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4000 W COAST HWY SUITE 3D
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2695
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Country | US
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Telephone | 949-642-8566
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Fax | 949-642-0746
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Provider Business Mailing Address
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Address Line | 4000 W COAST HWY SUITE 3D
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2695
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Country | US
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Telephone | 949-642-8566
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Fax | 949-642-0746
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KHOSROW MAHDAVI
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Credential | MD
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Telephone | 949-642-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | A33589
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | A33589
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License Number State | CA
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