Provider Demographics
NPI:1497417307
Name:OPTIMAL FOOT AND ANKLE INSTITUTE
Entity Type:Organization
Organization Name:OPTIMAL FOOT AND ANKLE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAKSHOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-725-3363
Mailing Address - Street 1:1220 MANNING AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5078
Mailing Address - Country:US
Mailing Address - Phone:410-725-3363
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2015
Practice Address - Country:US
Practice Address - Phone:410-725-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric