Healthcare Provider Details

I. General information

NPI: 1629029194
Provider Name (Legal Business Name): TALAKSOON KHADEMI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 SAN JUAN AVE.
EXETER CA
93221
US

IV. Provider business mailing address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-7300
  • Fax: 559-624-6590
Mailing address:
  • Phone: 559-624-2000
  • Fax: 559-732-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A9077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: