Healthcare Provider Details

I. General information

NPI: 1801903521
Provider Name (Legal Business Name): ARTIN ROUBEN KHODADADI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 SANTA MONICA BLVD STE 203
LOS ANGELES CA
90029-2339
US

IV. Provider business mailing address

5465 SANTA MONICA BLVD STE 203
LOS ANGELES CA
90029-2339
US

V. Phone/Fax

Practice location:
  • Phone: 323-466-6958
  • Fax: 323-466-7081
Mailing address:
  • Phone: 323-466-6958
  • Fax: 323-466-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: