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General NPI Number Information
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NPI Number | 1235123142
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Entity Type | Individual
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Provider Name | KHOSROW MEHRANY M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 1729 TULLY RD STE 9
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City | MODESTO
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State | CA
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Zip | 95350-4081
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Country | US
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Telephone | 209-338-7758
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Fax | 209-554-0311
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Provider Business Mailing Address
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Address Line | 64 MARIPOSA AVE
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City | LOS GATOS
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State | CA
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Zip | 95030-4317
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Country | US
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Telephone | 209-338-7758
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Fax | 209-554-0311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A87519
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License Number State | CA
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