Provider Demographics
NPI:1841490620
Name:KHOSROABADI, ALIREZA (DPM)
Entity type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:KHOSROABADI
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23164 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1101
Mailing Address - Country:US
Mailing Address - Phone:818-914-5686
Mailing Address - Fax:818-914-4573
Practice Address - Street 1:23164 VENTURA BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1101
Practice Address - Country:US
Practice Address - Phone:818-914-5686
Practice Address - Fax:818-408-2452
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4728213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22217Medicare PIN