Provider Demographics
NPI:1073721593
Name:KHOSROW MEHRANY M D INC
Entity Type:Organization
Organization Name:KHOSROW MEHRANY M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTION MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KHOSROW
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-603-6366
Mailing Address - Street 1:PO BOX 26310
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95159-6310
Mailing Address - Country:US
Mailing Address - Phone:408-335-3966
Mailing Address - Fax:408-292-2345
Practice Address - Street 1:1729 TULLY RD STE 9
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4081
Practice Address - Country:US
Practice Address - Phone:209-338-7758
Practice Address - Fax:209-554-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A875194Medicare ID - Type Unspecified
CAH16218Medicare UPIN