MEDICARE: NIMA KOHANGHADOSH PHARMD

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	183500000X	Pharmacist	68430	CA

General Provider Information

NPI Number	:	1790296903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMA KOHANGHADOSH PHARMD

Provider Business Mailing Address
First Line	:	1820 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4612
Country	:	US
Telephone Number	:	310-475-6000
Fax Number	:	310-475-2890

Provider Business Practice Location Address
First Line	:	1820 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4612
Country	:	US
Telephone Number	:	310-475-6000
Fax Number	:	310-475-2890

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

Provider Enumeration Date	:	10/14/2017
Last Update Date	:	10/31/2024

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