Provider Demographics
NPI:1235315631
Name:ROSTAM KHOSHSAR M D INC
Entity Type:Organization
Organization Name:ROSTAM KHOSHSAR M D INC
Other - Org Name:BIOHEALTH PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSHSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-360-0066
Mailing Address - Street 1:PO BOX 3129
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3129
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:15901 HAWTHORNE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-5801
Practice Address - Country:US
Practice Address - Phone:424-360-0066
Practice Address - Fax:424-360-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A884300Medicaid
CAW22081Medicare PIN