Provider Demographics
NPI:1184951345
Name:KHADEM, NEDA (OD)
Entity type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:KHADEM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 NUTMEG PL
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2500
Mailing Address - Country:US
Mailing Address - Phone:714-435-1150
Mailing Address - Fax:714-435-1250
Practice Address - Street 1:1545 NUTMEG PL
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2500
Practice Address - Country:US
Practice Address - Phone:714-435-1150
Practice Address - Fax:714-435-1250
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist