Provider Demographics
NPI:1932285566
Name:KHOSRAVI, MOHAMMAD RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:RYAN
Last Name:KHOSRAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2227
Mailing Address - Country:US
Mailing Address - Phone:310-247-9650
Mailing Address - Fax:
Practice Address - Street 1:50 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2227
Practice Address - Country:US
Practice Address - Phone:310-247-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84229208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery