Healthcare Provider Details

I. General information

NPI: 1306388426
Provider Name (Legal Business Name): KAVEH MOKHTARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16483 BERNARDO CENTER DR
SAN DIEGO CA
92128-2523
US

IV. Provider business mailing address

16483 BERNARDO CENTER DR
SAN DIEGO CA
92128-2523
US

V. Phone/Fax

Practice location:
  • Phone: 858-485-8558
  • Fax:
Mailing address:
  • Phone: 858-485-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 7007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: