Provider Demographics
NPI:1790183002
Name:KHAKHAM, CHIL (ND)
Entity Type:Individual
Prefix:DR
First Name:CHIL
Middle Name:
Last Name:KHAKHAM
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 ENCINITAS BLVD
Mailing Address - Street 2:316
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3762
Mailing Address - Country:US
Mailing Address - Phone:760-230-2922
Mailing Address - Fax:
Practice Address - Street 1:681 ENCINITAS BLVD
Practice Address - Street 2:SUITE 316
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3762
Practice Address - Country:US
Practice Address - Phone:760-230-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND817175F00000X
AZ14-1476175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty