Healthcare Provider Details

I. General information

NPI: 1649676123
Provider Name (Legal Business Name): KIMIA FAGHIHI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12626 RIVERSIDE DR STE 301
VALLEY VILLAGE CA
91607-3473
US

IV. Provider business mailing address

3631 OAKFIELD DR
SHERMAN OAKS CA
91423-4429
US

V. Phone/Fax

Practice location:
  • Phone: 818-452-9266
  • Fax: 707-873-7835
Mailing address:
  • Phone: 818-934-5173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: