Provider Demographics
NPI:1972191146
Name:NOWNEJAD, KAYVON (DC)
Entity type:Individual
Prefix:DR
First Name:KAYVON
Middle Name:
Last Name:NOWNEJAD
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 1:5862 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-1308
Mailing Address - Country:US
Mailing Address - Phone:323-233-4343
Mailing Address - Fax:323-233-1429
Practice Address - Street 1:5862 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-1308
Practice Address - Country:US
Practice Address - Phone:323-233-4343
Practice Address - Fax:323-233-1429
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor