Provider Demographics
NPI:1154580934
Name:DIBAGOHAR, HOMAN (DC)
Entity type:Individual
Prefix:
First Name:HOMAN
Middle Name:
Last Name:DIBAGOHAR
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 1:630 N PACIFIC COAST HWY STE 9A
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3439
Mailing Address - Country:US
Mailing Address - Phone:818-300-3266
Mailing Address - Fax:
Practice Address - Street 1:630 N PACIFIC COAST HWY STE 9A
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3439
Practice Address - Country:US
Practice Address - Phone:818-300-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor