Provider Demographics
NPI:1598124752
Name:TALAKSOON KHADEMI DO INC
Entity Type:Organization
Organization Name:TALAKSOON KHADEMI DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:TALAKSOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-909-9323
Mailing Address - Street 1:210 S JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6157
Mailing Address - Country:US
Mailing Address - Phone:559-909-9323
Mailing Address - Fax:
Practice Address - Street 1:400 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6237
Practice Address - Country:US
Practice Address - Phone:559-624-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9077207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AT6235Medicare PIN