Individual
DR. MOHAMMAD AMIN KHOSHNEVISAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
630 W 168TH ST RM 250, NEW YORK, NY 10032-3725
(212) 342-0424
(212) 305-9017
Mailing address
130 ELFRETHS ALY, PHILADELPHIA, PA 19106-2006
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30.026201
OH
122300000X
Dentist
DS042004
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
018001949
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
062474
NY
Other
Enumeration date
06/17/2015
Last updated
08/01/2022
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