Provider Demographics
NPI:1144495441
Name:HINZE, KHATEREH BAKHTAVAR (DC, PA-C)
Entity type:Individual
Prefix:DR
First Name:KHATEREH
Middle Name:BAKHTAVAR
Last Name:HINZE
Suffix:
Gender:F
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 GREENFIELD AVE
Mailing Address - Street 2:205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4460
Mailing Address - Country:US
Mailing Address - Phone:310-871-5851
Mailing Address - Fax:
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:106
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-542-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26340111N00000X
CAPA19728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor