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General NPI Number Information
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NPI Number | 1215107891
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Entity Type | Organization
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Legal Business Name | MOHAMMAD RYAN KHOSRAVI, MD INC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 50 N LA CIENEGA BLVD SUITE # 216
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2227
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Country | US
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Telephone | 310-247-9650
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Fax |
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Provider Business Mailing Address
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Address Line | 50 N LA CIENEGA BLVD SUITE # 216
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2227
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Country | US
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Telephone | 310-247-9650
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. MOHAMMAD RYAN KHOSRAVI
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Credential | M.D.
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Telephone | 310-247-9650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A84229
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License Number State | CA
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