Provider Demographics
NPI:1205032653
Name:KAIVAN-MEHR, AFSHIN (DC)
Entity Type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:
Last Name:KAIVAN-MEHR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-4915
Mailing Address - Country:US
Mailing Address - Phone:909-596-1038
Mailing Address - Fax:909-596-6059
Practice Address - Street 1:2138 BONITA AVE
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-4915
Practice Address - Country:US
Practice Address - Phone:909-596-1038
Practice Address - Fax:909-596-6059
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor