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General NPI Number Information
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NPI Number | 1922176239
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Entity Type | Individual
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Provider Name | MOHAMMAD ALI KHEZRIAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 1120 S DOBSON RD STE 225
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City | CHANDLER
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State | AZ
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Zip | 85286-6170
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Country | US
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Telephone | 480-728-5460
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Fax | 480-728-5461
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Provider Business Mailing Address
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Address Line | PO BOX 33269
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City | PHOENIX
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State | AZ
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Zip | 85067-3269
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37112
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 37112
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License Number State | AZ
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