1932464641 NPI number — SAHAND GOLSHAN-KHALILI D.P.M

Table of content: SAHAND GOLSHAN-KHALILI D.P.M (NPI 1932464641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932464641 NPI number — SAHAND GOLSHAN-KHALILI D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLSHAN-KHALILI
Provider First Name:
SAHAND
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932464641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 S LEMON AVE UNIT 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91788-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-405-8500
Provider Business Mailing Address Fax Number:
951-405-8555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4843 ARLINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92504-2760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-405-8500
Provider Business Practice Location Address Fax Number:
951-405-8555
Provider Enumeration Date:
07/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E5163 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)