Provider Demographics
NPI:1801903521
Name:KHODADADI, ARTIN ROUBEN (DC)
Entity type:Individual
Prefix:DR
First Name:ARTIN
Middle Name:ROUBEN
Last Name:KHODADADI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 SANTA MONICA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2339
Mailing Address - Country:US
Mailing Address - Phone:323-466-6958
Mailing Address - Fax:323-466-7081
Practice Address - Street 1:5465 SANTA MONICA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2339
Practice Address - Country:US
Practice Address - Phone:323-466-6958
Practice Address - Fax:323-466-7081
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor