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1255866695 NPI number — KHRANASA NESA MOHEBPOUR M.D.

NPI Number: 1255866695
Health Care Provider/Practitioner: KHRANASA NESA MOHEBPOUR M.D.

Information about “1255866695” NPI (KHRANASA NESA MOHEBPOUR M.D.) exists in 1255866695 in HTML format HTML  |  1255866695 in plain Text format TXT  |  1255866695 in PDF (Portable Document Format) PDF  |  1255866695 in an XML format XML  formats.

NPI Number : 1255866695 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255866695",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOHEBPOUR",
    "FirstName": "KHRANASA",
    "MiddleName": "NESA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12505 PRANAV LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUSTIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78750-1013",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "832-334-1403",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11714 WILSON PARKE AVE STE 150",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUSTIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78726-4061",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-768-8000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/24/2017",
    "LastUpdateDate": "07/09/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "S5707",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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