Provider Demographics
NPI:1427062348
Name:NIKAKHTAR, NEHZAT (MD)
Entity type:Individual
Prefix:
First Name:NEHZAT
Middle Name:
Last Name:NIKAKHTAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16444 PARAMOUNT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5453
Mailing Address - Country:US
Mailing Address - Phone:562-630-1220
Mailing Address - Fax:
Practice Address - Street 1:16444 PARAMOUNT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5453
Practice Address - Country:US
Practice Address - Phone:562-630-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36773OtherMD
CA00A367730Medicaid
CAA36773Medicare ID - Type Unspecified