Provider Demographics
NPI:1578717401
Name:KHOSRAVIANI, AVA (MD)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:KHOSRAVIANI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8950 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 171
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3561
Mailing Address - Country:US
Mailing Address - Phone:818-842-8000
Mailing Address - Fax:818-842-3208
Practice Address - Street 1:191 S BUENA VISTA ST
Practice Address - Street 2:SUITE 475
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:818-842-8000
Practice Address - Fax:818-842-3208
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2015-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA248462207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology