MEDICARE: JAHANGIR SANDALISAZAN JANFAZA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC12434	CA

General Provider Information

NPI Number	:	1073659223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAHANGIR SANDALISAZAN JANFAZA DC

Provider Business Mailing Address
First Line	:	PO BOX 2578
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213
Country	:	US
Telephone Number	:	310-859-8494
Fax Number	:	310-859-1573

Provider Business Practice Location Address
First Line	:	9025 WILSHIRE BLVD
Second Line	:	SUITE 200
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1825
Country	:	US
Telephone Number	:	310-859-8494
Fax Number	:	310-859-1573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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