Provider Demographics
NPI:1457429888
Name:MOKHTARI, AFSHIN (LAC)
Entity Type:Individual
Prefix:
First Name:AFSHIN
Middle Name:
Last Name:MOKHTARI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4325
Mailing Address - Country:US
Mailing Address - Phone:650-346-6506
Mailing Address - Fax:
Practice Address - Street 1:655 CASTRO ST STE 4
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-2019
Practice Address - Country:US
Practice Address - Phone:650-961-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10779171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist