Provider Demographics
NPI:1336275007
Name:KHOSHSAR, ROSTAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSTAM
Middle Name:
Last Name:KHOSHSAR
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:PO BOX 5273
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9678
Mailing Address - Country:US
Mailing Address - Phone:310-570-7191
Mailing Address - Fax:888-200-5909
Practice Address - Street 1:15901 HAWTHORNE BLVD
Practice Address - Street 2:STE 240
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-5801
Practice Address - Country:US
Practice Address - Phone:424-360-0066
Practice Address - Fax:424-360-0077
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88430207L00000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine