Provider Demographics
NPI:1003484387
Name:KHORRAMI, GHAZAL (MD)
Entity type:Individual
Prefix:
First Name:GHAZAL
Middle Name:
Last Name:KHORRAMI
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 1:251 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5004
Mailing Address - Country:US
Mailing Address - Phone:415-892-0965
Mailing Address - Fax:415-461-3792
Practice Address - Street 1:251 VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5004
Practice Address - Country:US
Practice Address - Phone:415-892-0965
Practice Address - Fax:415-461-3792
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA196676208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics