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FRED KHONSARI MEDICAL CORPORATION NPI 1275734410


NPI Information

NPI: 1275734410
Provider Name: FRED KHONSARI MEDICAL CORPORATION
Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 05D0578970

Address:
1140 W LA VETA AVE
SUITE # 605
ORANGE, CA
ZIP 92868
Phone: (714) 547-7457
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FRED KHONSARI MEDICAL CORPORATION is an urology in Orange, CA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. FRED KHONSARI MEDICAL CORPORATION NPI is 1275734410. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1140 W LA VETA AVE
SUITE # 605
ORANGE, CA
ZIP 92868-223
Phone: (714) 547-7457
Fax: (714) 547-6202

The provider's authorized official is Feraidoun Khonsari .
The authorized official title is Corporation President and has the following contact phone number (714) 547-7457.

The CLIA number assigned to this NPI record is 05D0578970 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/29/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208800000XUrologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100A310980MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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