Provider Demographics
NPI:1073293056
Name:ROSTAM KHOUBYARI, M.D., INC.
Entity Type:Organization
Organization Name:ROSTAM KHOUBYARI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOUBYARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-373-7040
Mailing Address - Street 1:15642 SAND CANYON AVE UNIT 53665
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-5423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 W COLLEGE ST STE 540
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1246
Practice Address - Country:US
Practice Address - Phone:213-673-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty