Provider Demographics
NPI:1033121272
Name:KHARAZMI, MOHAMMAD S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:S
Last Name:KHARAZMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MO
Other - Middle Name:
Other - Last Name:KHARAZMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4500 BROCKTON AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4027
Mailing Address - Country:US
Mailing Address - Phone:951-521-2357
Mailing Address - Fax:
Practice Address - Street 1:4500 BROCKTON AVE STE 305
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4027
Practice Address - Country:US
Practice Address - Phone:951-521-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2358207R00000X
CAG077981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046222803Medicaid
TX8U3492OtherBLUE CROSS BLUE SHIELD
TX8F1524Medicare ID - Type Unspecified
TX046222803Medicaid