Provider Demographics
NPI:1154306678
Name:KHALEGHI, BEHNAM (MD)
Entity Type:Individual
Prefix:
First Name:BEHNAM
Middle Name:
Last Name:KHALEGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W. LA VETA AVENUE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-628-9342
Mailing Address - Fax:714-628-9759
Practice Address - Street 1:805 W LA VETA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3901
Practice Address - Country:US
Practice Address - Phone:714-628-9342
Practice Address - Fax:714-628-9759
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54349207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC54349OtherLICENSE
PA075270Medicare PIN
H98545Medicare UPIN