Provider Demographics
NPI:1588607691
Name:KHORSANDI, MEHDI (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:KHORSANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:KHORSANDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1510 S CENTRAL AVE
Mailing Address - Street 2:600
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2500
Mailing Address - Country:US
Mailing Address - Phone:818-500-1676
Mailing Address - Fax:818-500-8360
Practice Address - Street 1:1510 S CENTRAL AVE
Practice Address - Street 2:600
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2500
Practice Address - Country:US
Practice Address - Phone:818-500-1676
Practice Address - Fax:818-500-8360
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52802207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology