# SEPEHR KHONSARI - A MEDICAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366717746
- **Authorized official:** DR. SEPEHR KHONSARI M.D, (PRESIDENT)
- **Authorized official phone:** (949) 334-7374

## Contact information

- **Practice address:** 2260 HOMET RD, SAN MARINO, CA 91108-1326
- **Practice address phone:** (949) 334-7374
- **Mailing address:** 2260 HOMET RD, SAN MARINO, CA 91108-1326
- **Mailing address phone:** (949) 334-7374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | A85324 | CA | Yes |

## Other

- **Enumeration date:** 03/19/2012
- **Last updated:** 03/19/2012