Provider Demographics
NPI:1013080696
Name:BEHJATI, KHOSROW ROY (MD)
Entity Type:Individual
Prefix:MR
First Name:KHOSROW
Middle Name:ROY
Last Name:BEHJATI
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 1:2333 KAPIOLANI BLVD
Mailing Address - Street 2:APT. 1902
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4485
Mailing Address - Country:US
Mailing Address - Phone:808-942-1780
Mailing Address - Fax:
Practice Address - Street 1:2333 KAPIOLANI BLVD
Practice Address - Street 2:APT. 1902
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-4485
Practice Address - Country:US
Practice Address - Phone:808-942-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG49311Medicare UPIN