MEDICARE: DR. KHODAYAR KHATIBLOU

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	34573	CA

General Provider Information

NPI Number	:	1598315244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHODAYAR KHATIBLOU

Provider Business Mailing Address
First Line	:	2900 BRISTOL ST STE J103
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-7918
Country	:	US
Telephone Number	:	949-742-2087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 BRISTOL ST STE J103
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-7918
Country	:	US
Telephone Number	:	949-742-2087
Fax Number	:

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

Provider Enumeration Date	:	09/15/2019
Last Update Date	:	04/07/2022

Similar Medicare Providers

1639270648 — PEGGY BOLCOA MFT
Practice Location Address:

2900 BRISTOL ST STE J101
COSTA MESA, CA
92626-7918

Practice Phone: 714-436-1800
Practice Fax:

1376981159 — DR. ANGELA MARIE CARAZA D.C., L.AC.
Practice Location Address:

2900 BRISTOL ST STE J102
COSTA MESA, CA
92626-7918

Practice Phone: 949-392-6490
Practice Fax: 949-392-6491

1760898225 — CARAZA-HA CHIROPRACTIC CORPORATION
Practice Location Address:

2900 BRISTOL ST STE J102
COSTA MESA, CA
92626-7918

Practice Phone: 949-392-6490
Practice Fax: 949-392-6491

1730644097 — DOROTHY COX PICKETT LMFT, MFC 36262
Practice Location Address:

2900 BRISTOL ST STE J101
COSTA MESA, CA
92626-7918

Practice Phone: 949-735-6880
Practice Fax:

1699391870 — VANESSA MACIEL LMT
Practice Location Address:

2900 BRISTOL ST STE J102
COSTA MESA, CA
92626-7918

Practice Phone: 949-392-6490
Practice Fax:

1720689813 — VICKY SUNSERI CMT
Practice Location Address:

2900 BRISTOL ST STE J102
COSTA MESA, CA
92626-7918

Practice Phone: 949-392-6490
Practice Fax:

Directions to “ DR. KHODAYAR KHATIBLOU ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.