Provider Demographics
NPI:1932187044
Name:MASOUD KHORSAND- SAHBAIE MD P A
Entity Type:Organization
Organization Name:MASOUD KHORSAND- SAHBAIE MD P A
Other - Org Name:KYMERA INDEPENDENT PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORSAND-SAHBAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-627-9110
Mailing Address - Street 1:PO BOX 1574
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1574
Mailing Address - Country:US
Mailing Address - Phone:575-627-9508
Mailing Address - Fax:877-749-7764
Practice Address - Street 1:400 MILITARY HEIGHTS PL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6407
Practice Address - Country:US
Practice Address - Phone:575-627-9500
Practice Address - Fax:877-749-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMST96299207RH0003X
NM96299207RH0003X
NMMD2007-0020207RH0003X
NMMD2011-0742207RH0003X
NMMD2012-0244207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM800521089OtherMEDICARE GROUP #
NMZ2565OtherMEDICAID GROUP NUMBER
NM1238400001OtherPALMETTO GBA
NMZ2565OtherMEDICAID GROUP NUMBER