Provider Demographics
NPI:1144379892
Name:KHALILI MALEK, SANAZ (DC)
Entity Type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:KHALILI MALEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 E HAMILTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0237
Mailing Address - Country:US
Mailing Address - Phone:408-379-0133
Mailing Address - Fax:408-379-3931
Practice Address - Street 1:256 E HAMILTON AVE STE F
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0237
Practice Address - Country:US
Practice Address - Phone:408-379-0133
Practice Address - Fax:408-379-3931
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor