Provider Demographics
NPI:1518945435
Name:KHALPARI, MOJGAN (DO)
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:
Last Name:KHALPARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CALIFORNIA AVE
Mailing Address - Street 2:1001
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3515
Mailing Address - Country:US
Mailing Address - Phone:310-451-1000
Mailing Address - Fax:310-451-1000
Practice Address - Street 1:6041 CADILLAC AVE
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1702
Practice Address - Country:US
Practice Address - Phone:323-851-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A65642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01161Medicare UPIN