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General NPI Number Information
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NPI Number | 1811967268
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Entity Type | Individual
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Provider Name | MEHRAN MIRKAZEMI D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 455 E THOUSAND OAKS BLVD STE 106
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5877
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Country | US
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Telephone | 805-908-6552
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Fax | 805-365-4115
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Provider Business Mailing Address
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Address Line | 455 E THOUSAND OAKS BLVD STE 106
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5877
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Country | US
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Telephone | 805-908-6552
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Fax | 805-365-4115
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20A24169
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5101013208
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License Number State | MI
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