Healthcare Provider Details

I. General information

NPI: 1689096356
Provider Name (Legal Business Name): JAHANDAR KHOEI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N CRESCENT DR APT 106
BEVERLY HILLS CA
90210-4850
US

IV. Provider business mailing address

240 N CRESCENT DR APT 106
BEVERLY HILLS CA
90210-4850
US

V. Phone/Fax

Practice location:
  • Phone: 310-696-0711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: