Provider Demographics
NPI:1790296903
Name:KOHANGHADOSH, NIMA (PHARMD)
Entity type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:KOHANGHADOSH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4612
Mailing Address - Country:US
Mailing Address - Phone:310-475-6000
Mailing Address - Fax:310-475-2890
Practice Address - Street 1:1820 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4612
Practice Address - Country:US
Practice Address - Phone:310-475-6000
Practice Address - Fax:310-475-2890
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-14
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist