Individual
JAVAD JAVADI KHOMAMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5541 MOSSVALE CIR, HUNTINGTON BEACH, CA 92649-4824
(714) 328-4030
Mailing address
5541 MOSSVALE CIR, HUNTINGTON BEACH, CA 92649-4824
(714) 328-4030
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 16695
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14915
MEDICARE #W14915
CA
Enumeration date
09/22/2006
Last updated
01/15/2008
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