=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679236996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOFI KETAMINE CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2021
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16661 VENTURA BLVD STE 707
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-851-0302
-----------------------------------------------------
Fax | 818-855-9621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16661 VENTURA BLVD STE 710
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-1991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANOOSH JAVAHERIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-308-5282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------