Provider Demographics
NPI:1326363300
Name:KHATIBI, NIKAN H (DO)
Entity Type:Individual
Prefix:DR
First Name:NIKAN
Middle Name:H
Last Name:KHATIBI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:29911 NIGUEL
Mailing Address - Street 2:#6429
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-9998
Mailing Address - Country:US
Mailing Address - Phone:888-873-6220
Mailing Address - Fax:888-873-6220
Practice Address - Street 1:1307 WEST 6TH STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-1944
Practice Address - Country:US
Practice Address - Phone:888-873-6220
Practice Address - Fax:888-873-6220
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2018-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A11914208VP0000X, 207LP2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program