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General NPI Number Information
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NPI Number | 1205652146
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Entity Type | Organization
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Legal Business Name | MOKHTARE MD, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2865 E COAST HWY UNIT 120
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2236
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Country | US
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Telephone | 866-278-2204
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Fax |
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Provider Business Mailing Address
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Address Line | 3141 MICHELSON DR UNIT 1704
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City | IRVINE
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State | CA
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Zip | 92612-5675
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Country | US
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Telephone | 949-287-6357
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Fax | 888-462-5010
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAHRZAD MOKHTARE
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Credential | MD
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Telephone | 949-735-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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