Provider Demographics
NPI:1417172644
Name:KANDKHOROV, ALBERT (DC)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:KANDKHOROV
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 1:13711 VAN NUYS BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3654
Mailing Address - Country:US
Mailing Address - Phone:818-890-6600
Mailing Address - Fax:818-890-7300
Practice Address - Street 1:13711 VAN NUYS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3654
Practice Address - Country:US
Practice Address - Phone:818-890-6600
Practice Address - Fax:818-890-7300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor