Physician Compare National (NPI:1831534197)

HEALTHCARE PROVIDER: JASON KHADAVI D.P.M.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1831534197
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395988091
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130828000448
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KHADAVI
	Individual professional last name
Provider First Name	JASON
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	12265 VENTURA BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 107
	Group Practice or individual's line 2 address
City	STUDIO CITY
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	916042530
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y