Individual
DR. KHOSROW SADRIEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4910 VAN NUYS BLVD, 110, SHERMAN OAKS, CA 91403-1782
(818) 986-8215
(818) 986-9582
Mailing address
4910 VAN NUYS BLVD, 110, SHERMAN OAKS, CA 91403-1782
(818) 986-8215
(818) 986-9582
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A29572
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A295720
—
CA
01
—
ZZZ48958Z
BLUE SHIELD PROVIDER #
CA
01
—
ZZZ97621Z
BLUE CROSS PROVIDER #
CA
Enumeration date
10/17/2006
Last updated
07/09/2007
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