Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lara Khosrovian

Individual provider Physician Assistant · NPI 1093556334

Lara Khosrovian is a Physician Assistant in Pomona, California. Qualified in 2024, 2 years ago. Practices with R Ajakwe MD and R Tatevossian MD a Professional Medical Corporation, a 7-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2024
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Practice location Address checks out

309 E 2nd St
Pomona, CA 91766-1854
Phone: (909) 623-6116
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 65289 (CA)

Record details

NPI number1093556334
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJune 3, 2024
Last updated in NPPESSeptember 22, 2025
Certification dateSeptember 22, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice R Ajakwe Md And R Tatevossian Md A Professional Medical Corporation — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Pomona