Provider Demographics
NPI:1346321841
Name:SAFAEI, HOUMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:HOUMAN
Middle Name:
Last Name:SAFAEI
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 1:5567 RESEDA BLVD
Mailing Address - Street 2:STE 219
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2600
Mailing Address - Country:US
Mailing Address - Phone:818-342-3030
Mailing Address - Fax:818-342-3030
Practice Address - Street 1:5567 RESEDA BLVD
Practice Address - Street 2:STE 219
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2600
Practice Address - Country:US
Practice Address - Phone:818-342-3030
Practice Address - Fax:818-342-3030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28162111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89215Medicare UPIN
CADC28162AMedicare PIN