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General NPI Number Information
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NPI Number | 1912384611
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Entity Type | Individual
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Provider Name | GOHAR KHOSRAVI M.D
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 02/04/2023
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Provider Practice Location Address
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Address Line | 11401 BLOOMFIELD AVE
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City | NORWALK
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State | CA
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Zip | 90650-2015
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Country | US
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Telephone | 949-331-9781
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 N KRAEMER BLVD UNIT 171
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City | PLACENTIA
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State | CA
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Zip | 92871-1408
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Country | US
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Telephone | 657-341-4422
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A158461
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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