Vista S Khosravi, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G80120 Issued in CA

Practice address

80 Great Oaks Blvd
San Jose, CA 95119-1310

Phone

(408) 363-3000

NPI assigned

Aug 13, 2006

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• VA Palo Alto Healthcare System

  • VA Clinic/Center
  • San Jose, CA
  • NPI 1003206244
  NPD (past)

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407868789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 MONTELLANO CT",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951204833",
            "telephone_number": "408-927-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 GREAT OAKS BLVD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951191310",
            "telephone_number": "408-363-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOSRAVI",
        "first_name": "VISTA",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G80120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Anne Khong, O.D.
• Ayla Khoshaba
• Monica Khoshabian
• Niloufar Khoshzamir
• Anjana Khosla
• Khouri Dental Group (Advanced Dentistry by Design)
• Michelle Khouri, DDS
• Laura Khoury, PH.D.
• Nicola Elias Khoury, DDS
• Angela Khov

• Dermatology Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.