Provider Demographics
NPI:1669899258
Name:KHAN-SHAGHAGHI, YASAMAN (DC)
Entity type:Individual
Prefix:DR
First Name:YASAMAN
Middle Name:
Last Name:KHAN-SHAGHAGHI
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 1:300 N. WASHINGTON STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:703-560-4730
Mailing Address - Fax:703-560-4731
Practice Address - Street 1:300 N. WASHINGTON STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-560-4730
Practice Address - Fax:703-560-4731
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557106111N00000X
TX12432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor