Provider Demographics
NPI:1477618452
Name:JAFARI, MAHINDOKHT (DO)
Entity Type:Individual
Prefix:
First Name:MAHINDOKHT
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DOKHI
Other - Middle Name:
Other - Last Name:JAFARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:855 N LARK ELLEN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1099
Mailing Address - Country:US
Mailing Address - Phone:626-966-9601
Mailing Address - Fax:626-966-1440
Practice Address - Street 1:855 N LARK ELLEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1099
Practice Address - Country:US
Practice Address - Phone:626-966-9601
Practice Address - Fax:626-966-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6716208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47417Medicare UPIN