Provider Demographics
NPI:1811586076
Name:KADKHODA, NIKKI (PA-C)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:KADKHODA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15477 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3046
Mailing Address - Country:US
Mailing Address - Phone:818-906-6900
Mailing Address - Fax:
Practice Address - Street 1:15477 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3046
Practice Address - Country:US
Practice Address - Phone:818-906-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant