Provider Demographics
NPI:1770110553
Name:KHOSRAWIPOUR, VERIA (MD)
Entity type:Individual
Prefix:DR
First Name:VERIA
Middle Name:
Last Name:KHOSRAWIPOUR
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:GROPIUSWEG 21
Mailing Address - Street 2:
Mailing Address - City:BOCHUM
Mailing Address - State:NRW
Mailing Address - Zip Code:44801
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 CITY BLVD W STE 1600
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5903
Practice Address - Country:US
Practice Address - Phone:714-509-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2044795208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
382316720OtherADAC