Provider Demographics
NPI:1528138823
Name:CAMERON KHAVRIAN, MD INC
Entity type:Organization
Organization Name:CAMERON KHAVRIAN, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-645-8475
Mailing Address - Street 1:320 SUPERIOR AVENUE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2742
Mailing Address - Country:US
Mailing Address - Phone:949-645-8475
Mailing Address - Fax:855-213-1762
Practice Address - Street 1:320 SUPERIOR AVENUE
Practice Address - Street 2:SUITE 320
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2742
Practice Address - Country:US
Practice Address - Phone:949-645-8475
Practice Address - Fax:855-213-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92892Medicare UPIN
CAH92892Medicare UPIN