Provider Demographics
NPI:1477855856
Name:KHASHAYAR SARABI MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:KHASHAYAR SARABI MD A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SARABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-893-3884
Mailing Address - Street 1:1512 TREASURE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2463
Mailing Address - Country:US
Mailing Address - Phone:310-893-3884
Mailing Address - Fax:818-343-1677
Practice Address - Street 1:250 E YALE LOOP STE E
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4697
Practice Address - Country:US
Practice Address - Phone:310-893-3884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105478208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty