Individual
POUYA KHANKHANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, 2 RAVDIN, PHILADELPHIA, PA 19104-4238
(215) 662-3606
(215) 349-5579
Mailing address
3400 SPRUCE ST, 2 RAVDIN, PHILADELPHIA, PA 19104-4238
(215) 662-3606
(215) 349-5579
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
81266
WI
2084N0400X
Neurology Physician
Primary
MD465098
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100224404
—
WI
Enumeration date
04/07/2014
Last updated
02/01/2023
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