Provider Demographics
NPI:1144324351
Name:AFSARI, KHOSROW (FACP MD)
Entity type:Individual
Prefix:DR
First Name:KHOSROW
Middle Name:
Last Name:AFSARI
Suffix:
Gender:M
Credentials:FACP MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 VALE RD
Mailing Address - Street 2:#21
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-232-9065
Mailing Address - Fax:510-232-0805
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:#21
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-232-9065
Practice Address - Fax:510-232-0805
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30573207R00000X
CAA 30573207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A30573Medicaid
CA00A30573Medicaid
A87408Medicare UPIN