Provider Demographics
NPI:1861815771
Name:MOHSEN KHERADPEZHOUH MD, INC
Entity Type:Organization
Organization Name:MOHSEN KHERADPEZHOUH MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHERADPEZHOUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-248-0364
Mailing Address - Street 1:10465 EASTBORNE AVE
Mailing Address - Street 2:APT 306
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6181
Mailing Address - Country:US
Mailing Address - Phone:818-248-0364
Mailing Address - Fax:818-247-1330
Practice Address - Street 1:10465 EASTBORNE AVE
Practice Address - Street 2:APT 306
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-6181
Practice Address - Country:US
Practice Address - Phone:818-248-0364
Practice Address - Fax:818-247-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty