Provider Demographics
NPI:1073361002
Name:KIMIABAKHSH, CHLOE (NP)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:KIMIABAKHSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1234
Mailing Address - Country:US
Mailing Address - Phone:516-680-4647
Mailing Address - Fax:
Practice Address - Street 1:38 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1234
Practice Address - Country:US
Practice Address - Phone:516-680-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95234260163W00000X
NY789857163W00000X
NY353837363LF0000X
CA95028751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse