Provider Demographics
NPI:1942257712
Name:KHAJAVI, SOHEILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOHEILA
Middle Name:
Last Name:KHAJAVI
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 1:4584 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6001
Mailing Address - Country:US
Mailing Address - Phone:415-872-6922
Mailing Address - Fax:707-996-4859
Practice Address - Street 1:4584 BELMONT CT
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6001
Practice Address - Country:US
Practice Address - Phone:415-872-6922
Practice Address - Fax:707-996-4859
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA442142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44214OtherLICENSURE