Provider Demographics
NPI:1871524702
Name:KHOSRO SADEGHANI MD. INC
Entity type:Organization
Organization Name:KHOSRO SADEGHANI MD. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHOSRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-7546
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-990-7546
Mailing Address - Fax:818-990-9442
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-990-7546
Practice Address - Fax:818-990-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19579Medicare ID - Type Unspecified