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General NPI Number Information
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NPI Number | 1578311015
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY VASCULAR & ENDOCRINOLOGY CENTER PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/09/2024
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 2220 LYNN RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1904
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Country | US
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Telephone | 661-395-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 LYNN RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1904
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Country | US
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Telephone | 661-395-3055
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KHAZAI BAHRAM
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Credential | M.D.
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Telephone | 615-557-6692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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