Healthcare Provider Details

I. General information

NPI: 1982907663
Provider Name (Legal Business Name): PAYMAN JAVAHERIAN D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18055 VENTURA BLVD
ENCINO CA
91316-3517
US

IV. Provider business mailing address

PO BOX 571746
TARZANA CA
91357-1746
US

V. Phone/Fax

Practice location:
  • Phone: 818-521-9470
  • Fax: 818-521-9470
Mailing address:
  • Phone: 818-521-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: