Provider Demographics
NPI:1043545957
Name:ALEX A. KHADAVI MD INC
Entity Type:Organization
Organization Name:ALEX A. KHADAVI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-974-7954
Mailing Address - Street 1:8539 W SUNSET BLVD
Mailing Address - Street 2:SUITE 4 BOX 132
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2334
Mailing Address - Country:US
Mailing Address - Phone:661-974-7954
Mailing Address - Fax:661-974-8365
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5103
Practice Address - Country:US
Practice Address - Phone:818-528-2500
Practice Address - Fax:818-528-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty