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Provider Information for 1720275217



DR. ALI M KHOSROVANI DDS

Other Name:   ALI KHOSROVANI
Gender: MALE

Individual NPI: 1720275217

Calendar Last Updated: 2011-01-28

Details

Name Value
NPI 1720275217
Enumeration Date 2007-09-27
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 4905 YORK BLVD
LOS ANGELES, CA 90042-1609
United States

Phone: 323-255-8774 | Fax: 323-255-6259
View Map External Link
Primary Practice Address 4905 YORK BLVD
LOS ANGELES, CA 90042-2022
United States

Phone: 310-968-9192 | Fax: 310-575-9822
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 56085
Other Identifiers
Issuer State Number