Provider Demographics
NPI:1316287428
Name:KOUHNAVARD, MOHAMMAD REZA (DC)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:REZA
Last Name:KOUHNAVARD
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 1:2907 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4536
Mailing Address - Country:US
Mailing Address - Phone:818-729-8540
Mailing Address - Fax:
Practice Address - Street 1:2907 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4536
Practice Address - Country:US
Practice Address - Phone:818-729-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor