MEDICARE: SABA SADAT KHANSARI PA-C

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	PA60973	CA
2	363A00000X	Physician Assistant	PA60973	CA

General Provider Information

NPI Number	:	1467000802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABA SADAT KHANSARI PA-C

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:	323-467-7119

Provider Business Practice Location Address
First Line	:	1811 N WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3403
Country	:	US
Telephone Number	:	855-783-2434
Fax Number	:

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	05/07/2024

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