Provider Demographics
NPI:1215953476
Name:OKHOVAT, MAHYAR (MD)
Entity type:Individual
Prefix:DR
First Name:MAHYAR
Middle Name:
Last Name:OKHOVAT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 SANTA MONICA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7558
Mailing Address - Country:US
Mailing Address - Phone:818-918-2766
Mailing Address - Fax:818-921-4168
Practice Address - Street 1:11022 SANTA MONICA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7558
Practice Address - Country:US
Practice Address - Phone:805-557-0096
Practice Address - Fax:805-557-7360
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA856462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A856460OtherMEDICAL PPIN #
CAWA85646AMedicare ID - Type UnspecifiedPPIN #
CA00A856460OtherMEDICAL PPIN #