MEDICARE: KHOSROW MOSTOFI 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	207R00000X	Internal Medicine Physician	A50643	CA

General Provider Information

NPI Number	:	1457610842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHOSROW MOSTOFI M.D.

Provider Business Mailing Address
First Line	:	2009 MOUNTAIN OAK RD
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-1611
Country	:	US
Telephone Number	:	661-664-9687
Fax Number	:	661-664-9687

Provider Business Practice Location Address
First Line	:	2009 MOUNTAIN OAK RD
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311
Country	:	US
Telephone Number	:	661-664-9687
Fax Number	:	661-664-9687

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

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	05/07/2012

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