Lara Khosrovian

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

65289 Issued in CA

Practice address

309 E 2ND St
Pomona, CA 91766-1854

Phone

(909) 623-6116

NPI assigned

Jun 3, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

R Ajakwe MD and R Tatevossian MD a Professional Medical CorporationGroup PAC ID 3173744604, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: lara.khosrovian@1781.securemail.prognocis.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• R Ajakwe MD and R Tatevossian MD a Professional Medical Corporation

  • Pain Medicine Physician
  • Burbank, CA
  • NPI 1881009108
  Medicare reassignment Care Compare group
• Alexander S Tovar MD a Professional Corporation

  • Specialist
  • Burbank, CA
  • NPI 1063845782
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health System - Southern California

  • General Acute Care Hospital
  • Burbank, CA
  • NPI 1336173269
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1093556334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11539 DELLMONT DR",
            "city": "TUJUNGA",
            "state": "CA",
            "postal_code": "910421112",
            "telephone_number": "818-472-7215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854",
            "telephone_number": "909-623-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOSROVIAN",
        "first_name": "LARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-03",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "65289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andre Elias Khawam, DO
• Celine Khazen
• Nicole Khezri, MD
• Sepehr Khonsari, M.D.
• Ali Khosravi, DO
• Mohammad Khoudari
• Tabitha W Kiama
• Maureen Nyambura Kibara
• Samuel Kibara, APRN
• Mandi Moxie Kibel

• Physician Assistant in Pomona, CA
• Providers in Pomona, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.