Provider Demographics
NPI:1851182711
Name:KHOSRAVI, ALI (DO)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:KHOSRAVI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12241 ARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2805
Mailing Address - Country:US
Mailing Address - Phone:949-343-7157
Mailing Address - Fax:
Practice Address - Street 1:12241 ARLINGTON PL
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2805
Practice Address - Country:US
Practice Address - Phone:949-343-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program