Provider Demographics
NPI:1942674080
Name:KAJBAF, OMID ALEX (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:OMID
Middle Name:ALEX
Last Name:KAJBAF
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 VALLEY SPRING LN UNIT 106
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3278
Mailing Address - Country:US
Mailing Address - Phone:310-614-8846
Mailing Address - Fax:
Practice Address - Street 1:10604 VALLEY SPRING LN
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-3277
Practice Address - Country:US
Practice Address - Phone:310-614-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-29
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist