Provider Demographics
NPI:1306957329
Name:KHODABAKHSH, AFSHIN JAMES (MD)
Entity type:Individual
Prefix:
First Name:AFSHIN
Middle Name:JAMES
Last Name:KHODABAKHSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N BEDFORD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4322
Mailing Address - Country:US
Mailing Address - Phone:310-273-2333
Mailing Address - Fax:310-273-6583
Practice Address - Street 1:416 N BEDFORD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4322
Practice Address - Country:US
Practice Address - Phone:310-273-2333
Practice Address - Fax:310-273-6583
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85260207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85260Medicare ID - Type Unspecified
H19981Medicare UPIN