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General NPI Number Information
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NPI Number | 1750315362
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Entity Type | Individual
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Provider Name | KHOSRO SADEGHANI MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 11333 SEPULVEDA BLVD
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City | MISSION HILLS
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State | CA
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Zip | 91345-1116
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Country | US
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Telephone | 818-837-5778
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Fax | 818-837-5774
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Provider Business Mailing Address
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Address Line | PO BOX 9602
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City | MISSION HILLS
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State | CA
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Zip | 91346-9602
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Country | US
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Telephone | 818-837-5637
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Fax | 818-837-5589
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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 | A49841
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A49841
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License Number State | CA
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