Provider Demographics
NPI:1922484054
Name:MAHYAR OKHOVAT, M.D. INC
Entity Type:Organization
Organization Name:MAHYAR OKHOVAT, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:OKHOVAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-590-4445
Mailing Address - Street 1:3436 ALANA DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4703
Mailing Address - Country:US
Mailing Address - Phone:818-590-4445
Mailing Address - Fax:949-861-6592
Practice Address - Street 1:2925 CANWOOD ST
Practice Address - Street 2:109
Practice Address - City:AGOURAL HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-590-4445
Practice Address - Fax:949-861-6592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA856462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty