MEDICARE: DR. SHAHRAM KHORSHIDI M.D.

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	207Q00000X	Family Medicine Physician	A101047	CA

General Provider Information

NPI Number	:	1366621914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHRAM KHORSHIDI M.D.

Provider Business Mailing Address
First Line	:	5405 OBERLIN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1700
Country	:	US
Telephone Number	:	619-784-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	5405 OBERLIN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1700
Country	:	US
Telephone Number	:	619-784-1314
Fax Number	:

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	06/01/2026

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