Provider Demographics
NPI:1740172097
Name:KHAYAMBASHI, KHALIL (DPT)
Entity type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:
Last Name:KHAYAMBASHI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:KHALIL
Other - Middle Name:KHAYAM
Other - Last Name:BASHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15125 VENTURA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3306
Mailing Address - Country:US
Mailing Address - Phone:818-646-0046
Mailing Address - Fax:
Practice Address - Street 1:15125 VENTURA BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3306
Practice Address - Country:US
Practice Address - Phone:818-646-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist