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General NPI Number Information
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NPI Number | 1881030484
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Entity Type | Organization
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Legal Business Name | KHASHAYAR MOHEBALI MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 21 TAMAL VISTA BLVD SUITE 103
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City | CORTE MADERA
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State | CA
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Zip | 94925-1130
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Country | US
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Telephone | 415-927-7660
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Fax | 415-927-7663
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Provider Business Mailing Address
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Address Line | 548 COLUMBIA CREEK DR
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City | SAN RAMON
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State | CA
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Zip | 94582-5611
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Country | US
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Telephone | 925-556-4336
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Fax | 925-556-9270
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KHASHAYAR MOHEBALI
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Credential | MD
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Telephone | 415-412-4921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A94434
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License Number State | CA
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