Provider Demographics
NPI:1457557100
Name:KHAMSI, BABAK RAZAGHI (MD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:RAZAGHI
Last Name:KHAMSI
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 1:6276 RIVER CREST DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0783
Mailing Address - Country:US
Mailing Address - Phone:951-413-0200
Mailing Address - Fax:951-653-5680
Practice Address - Street 1:6276 RIVER CREST DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0783
Practice Address - Country:US
Practice Address - Phone:951-413-0200
Practice Address - Fax:951-653-5680
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA119808390200000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023079183Medicaid
CA1023079183Medicaid