MEDICARE: DR. DARYOUSH KHANI 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	2085B0100X	Body Imaging Physician	A22000	CA

General Provider Information

NPI Number	:	1609070218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARYOUSH KHANI M.D.

Provider Business Mailing Address
First Line	:	2932 WILSHIRE BLVD STE 206
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4946
Country	:	US
Telephone Number	:	310-829-7503
Fax Number	:	310-453-9542

Provider Business Practice Location Address
First Line	:	2932 WILSHIRE BLVD STE 206
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4946
Country	:	US
Telephone Number	:	310-829-7503
Fax Number	:	310-453-9542

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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