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Individual

REZA KHORSAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1245 16TH ST STE 309, SANTA MONICA, CA 90404-1239
(310) 319-4371
(310) 319-4141
Mailing address
1245 16TH ST STE 309, SANTA MONICA, CA 90404-1239
(310) 319-4371
(310) 319-4141

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A101659
CA
207RN0300X
Nephrology Physician
Primary
A101659
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1356536585
CA
Enumeration date
09/11/2007
Last updated
09/12/2011
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