Provider Demographics
NPI:1982888152
Name:AMIRIKHORHEH, KEYVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEYVAN
Middle Name:
Last Name:AMIRIKHORHEH
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 1:485 CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1830 W OLYMPIC BLVD
Practice Address - Street 2:UNIT 124
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3734
Practice Address - Country:US
Practice Address - Phone:213-383-1183
Practice Address - Fax:213-383-1184
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55422208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA55422OtherCALIFORNIA MEDICAL BOARD