Provider Demographics
NPI:1033825138
Name:KHALILPOUR, ORHAN
Entity Type:Individual
Prefix:
First Name:ORHAN
Middle Name:
Last Name:KHALILPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20555 DEVONSHIRE ST # 455
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3208
Mailing Address - Country:US
Mailing Address - Phone:818-919-5620
Mailing Address - Fax:
Practice Address - Street 1:22001 MAYALL ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2822
Practice Address - Country:US
Practice Address - Phone:818-919-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist