MEDICARE: ROSTAM KHOUBYARI, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1073293056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSTAM KHOUBYARI, M.D., INC.

Provider Business Mailing Address
First Line	:	15642 SAND CANYON AVE UNIT 53665
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92619-5423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 W COLLEGE ST STE 540
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1246
Country	:	US
Telephone Number	:	213-673-1880
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROSTAM KHOUBYARI
Credential	:	MD
Telephone Number	:	408-373-7040

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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