MEDICARE: DR. CHRISTOPHER KHORSANDI MD

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	A104346	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	13044	NV

General Provider Information

NPI Number	:	1235376377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER KHORSANDI MD

Provider Business Mailing Address
First Line	:	4616 W SAHARA AVE
Second Line	:	SUITE 376
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	702-608-1318
Fax Number	:

Provider Business Practice Location Address
First Line	:	2779 SUNRIDGE HEIGHTS PKWY
Second Line	:	STE 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-5050
Country	:	US
Telephone Number	:	702-608-1318
Fax Number	:	702-446-8026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	02/20/2014

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