Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC22785 | CA |
NPI | 1043398589 |
---|---|
Provider Name | Dr. Sevak E. Khodabakhshian |
First Address | Thousand Oaks, CA 91361-1087 |
Second Address | Thousand Oaks, CA 91361-1087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |