MEDICARE: INTEGRATIVE MIND AND MEDICINE INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0805X	Geriatric Psychiatry Physician
3	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1437076262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE MIND AND MEDICINE INC.

Provider Business Mailing Address
First Line	:	3808 W RIVERSIDE DR STE 503
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-5301
Country	:	US
Telephone Number	:	747-292-5257
Fax Number	:	747-286-7933

Provider Business Practice Location Address
First Line	:	3808 W RIVERSIDE DR STE 503
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-5301
Country	:	US
Telephone Number	:	747-292-5257
Fax Number	:	747-286-7933

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	CHRISTOPHER KHOSHORYAN
Credential	:	MD
Telephone Number	:	747-286-7933

Provider Enumeration Date	:	07/02/2026
Last Update Date	:	07/02/2026

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