Provider Demographics
NPI:1770803116
Name:KHATAMI, ARASH (MD)
Entity type:Individual
Prefix:DR
First Name:ARASH
Middle Name:
Last Name:KHATAMI
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:P.O. BOX 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944
Mailing Address - Country:US
Mailing Address - Phone:858-367-3020
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE A215
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1711
Practice Address - Country:US
Practice Address - Phone:858-367-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1149532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry