Individual
DR. KHOSROW MAHDAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1640 NEWPORT BLVD STE 400, COSTA MESA, CA 92627-3786
(949) 999-2400
Mailing address
200 S MANCHESTER AVE STE 300, ORANGE, CA 92868-3219
(714) 456-2986
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A33589
CA
207RH0000X
Hematology (Internal Medicine) Physician
A33589
CA
207RH0003X
Hematology & Oncology Physician
Primary
A33589
CA
207RX0202X
Medical Oncology Physician
A33589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A33589
LICENSE NUMBER
CA
Enumeration date
05/27/2005
Last updated
11/15/2023
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