Provider Demographics
NPI:1508305129
Name:AKHAVAN-RAJABI, ALI (DC)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:AKHAVAN-RAJABI
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 1:3404 W VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1544
Mailing Address - Country:US
Mailing Address - Phone:818-582-8862
Mailing Address - Fax:
Practice Address - Street 1:3404 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1544
Practice Address - Country:US
Practice Address - Phone:818-582-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4685111N00000X
CA34627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor