Healthcare Provider Details

I. General information

NPI: 1386991396
Provider Name (Legal Business Name): KYLE KAMRAN JAHANGIRI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32663 KENITA WAY
UNION CITY CA
94587-3001
US

IV. Provider business mailing address

32663 KENITA WAY
UNION CITY CA
94587-3001
US

V. Phone/Fax

Practice location:
  • Phone: 510-415-9175
  • Fax:
Mailing address:
  • Phone: 510-415-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number32362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: