Provider Demographics
NPI:1912020785
Name:KHAVARI, RAZ (MD)
Entity Type:Individual
Prefix:MISS
First Name:RAZ
Middle Name:
Last Name:KHAVARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15243 VANOWEN ST
Mailing Address - Street 2:STE 306
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3605
Mailing Address - Country:US
Mailing Address - Phone:818-781-0232
Mailing Address - Fax:818-781-4132
Practice Address - Street 1:15243 VANOWEN ST STE 306
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3649
Practice Address - Country:US
Practice Address - Phone:818-781-0232
Practice Address - Fax:818-781-4132
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94272207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16712OtherMEDICARE PTAN