Individual
ANOUSH ANN KHODAVERDIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6327 N FRESNO ST, SUITE 108, FRESNO, CA 93710-5236
(559) 440-0110
(559) 440-0401
Mailing address
777 N. SHEPHERD AVENUE, FRESNO, CA 93720
(559) 433-1723
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0A437870
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000A437870
—
CA
Enumeration date
07/04/2006
Last updated
12/29/2011
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