Provider Demographics
NPI:1841220621
Name:KHADAVI, ALAN OMID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:OMID
Last Name:KHADAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1838
Mailing Address - Country:US
Mailing Address - Phone:310-282-8822
Mailing Address - Fax:424-239-1033
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1838
Practice Address - Country:US
Practice Address - Phone:310-282-8822
Practice Address - Fax:424-239-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227126207KA0200X, 208000000X
CAA109088207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI50531Medicare UPIN
CACX184AMedicare Oscar/Certification