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General NPI Number Information
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NPI Number | 1225526718
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Entity Type | Individual
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Provider Name | BAHRAM HESHMATIPOUR
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Gender | Male
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 5353 BALBOA BLVD
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City | ENCINO
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State | CA
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Zip | 91316-2804
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Country | US
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Telephone | 818-387-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 23245 W VAIL DR
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City | WEST HILLS
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State | CA
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Zip | 91307-1449
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Country | US
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Telephone | 949-514-7728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 17592
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License Number State | CA
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