Provider Demographics
NPI:1609070218
Name:KHANI, DARYOUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYOUSH
Middle Name:
Last Name:KHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:KHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2932 WILSHIRE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4946
Mailing Address - Country:US
Mailing Address - Phone:310-829-7503
Mailing Address - Fax:310-453-9542
Practice Address - Street 1:2932 WILSHIRE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4946
Practice Address - Country:US
Practice Address - Phone:310-829-7503
Practice Address - Fax:310-453-9542
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA220002085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging