Organization
REVIVE PAIN & SPINE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AKBAR KHAN DO (PRESIDENT OF CORPORATION)
(530) 650-8333
Entity
Organization
Contact information
Practice address
3609 MISSION AVE STE D, CARMICHAEL, CA 95608-2955
(530) 650-8333
(530) 650-8388
Mailing address
255 W COURT ST STE D, WOODLAND, CA 95695-2986
(530) 650-8333
(530) 650-8388
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
20A13486
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407843162
INDIVIDUAL NPI
OH
01
—
1528383833
INDIVIDUAL NPI
CA
Enumeration date
08/14/2018
Last updated
10/28/2024
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