Provider Demographics
NPI:1528074812
Name:GOLCHINI, KEIVAN (MD)
Entity type:Individual
Prefix:
First Name:KEIVAN
Middle Name:
Last Name:GOLCHINI
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 1:9100 WILSHIRE BLVD
Mailing Address - Street 2:# 245 EAST
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-276-7649
Mailing Address - Fax:714-602-6784
Practice Address - Street 1:11835 W OLYMPIC BLVD
Practice Address - Street 2:STE 855E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5060
Practice Address - Country:US
Practice Address - Phone:310-276-7649
Practice Address - Fax:714-602-6784
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A488001Medicaid
CAF13853Medicare UPIN
CAA48800Medicare ID - Type Unspecified