Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC30637 | CA |
NPI | 1255607586 |
---|---|
Provider Name | Zareena Khan |
First Address | Beverely, CA 90212 |
Second Address | Beverely, CA 90212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 30/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC30637 | CHIROPRACTIC CA BOARD (01) | CA |