Provider Demographics
NPI:1407914138
Name:KHOSH, MEHDI L (ND)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:L
Last Name:KHOSH
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 QUAIL CREST PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3838
Mailing Address - Country:US
Mailing Address - Phone:785-749-2255
Mailing Address - Fax:
Practice Address - Street 1:4824 QUAIL CREST PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3838
Practice Address - Country:US
Practice Address - Phone:785-749-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-A00002171100000X
KS21-00002175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist