Provider Demographics
NPI:1871026765
Name:KHECHOOMAN, ARTINEH
Entity Type:Individual
Prefix:
First Name:ARTINEH
Middle Name:
Last Name:KHECHOOMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N CEDAR ST
Mailing Address - Street 2:APT 4
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4904
Mailing Address - Country:US
Mailing Address - Phone:818-624-1615
Mailing Address - Fax:
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2011
Practice Address - Country:US
Practice Address - Phone:818-624-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician