Provider Demographics
NPI:1851737860
Name:KHODADADI, FARNAZ (DC)
Entity Type:Individual
Prefix:DR
First Name:FARNAZ
Middle Name:
Last Name:KHODADADI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17772 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6819
Mailing Address - Country:US
Mailing Address - Phone:949-433-6909
Mailing Address - Fax:
Practice Address - Street 1:17772 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-1125
Practice Address - Country:US
Practice Address - Phone:949-433-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27461111NR0400X
CA95019083363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No111NR0400XChiropractic ProvidersChiropractorRehabilitation