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General NPI Number Information
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NPI Number | 1669799110
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Entity Type | Individual
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Provider Name | YASHAR ILKHCHOUI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 1328 22ND ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-2032
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Country | US
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Telephone | 310-829-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1000
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Fax | 714-647-1245
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD2013-0062
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A135166
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License Number State | CA
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