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General NPI Number Information
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NPI Number | 1558879924
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Entity Type | Organization
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Legal Business Name | JASON KHADAVI DPM, INC.
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD STE 820
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City | ENCINO
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State | CA
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Zip | 91436-4801
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Country | US
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Telephone | 424-377-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 10707 MISSOURI AVE APT 301
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City | LOS ANGELES
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State | CA
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Zip | 90025-6360
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Country | US
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Telephone | 818-642-3660
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON KHADAVI
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Credential |
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Telephone | 818-642-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | E5064
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License Number State | CA
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