Provider Demographics
NPI:1942736301
Name:KHADEMI, TANIN (DC)
Entity Type:Individual
Prefix:
First Name:TANIN
Middle Name:
Last Name:KHADEMI
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 1:3250 WILSHIRE BLVD STE 1501
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1608
Mailing Address - Country:US
Mailing Address - Phone:213-291-0505
Mailing Address - Fax:
Practice Address - Street 1:3250 WILSHIRE BLVD STE 1501
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1608
Practice Address - Country:US
Practice Address - Phone:213-291-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor