Healthcare Provider Details

I. General information

NPI: 1972748176
Provider Name (Legal Business Name): JAMSHIED BAKSHODEH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 S COAST DR STE 303
COSTA MESA CA
92626-1528
US

IV. Provider business mailing address

1503 S COAST DR STE 303
COSTA MESA CA
92626-1528
US

V. Phone/Fax

Practice location:
  • Phone: 714-438-3900
  • Fax:
Mailing address:
  • Phone: 714-438-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number30332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: