Individual provider Active NPI

Talaksoon Khademi, DO

  • Obstetrics & Gynecology Physician
  • Exeter, CA
National Provider Identifier
1629029194
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
20A9077 Issued in CA
Practice address
1014 San Juan Ave.
Exeter, CA 93221
Phone
(559) 592-7300
Fax
(559) 624-6590
NPI assigned
May 12, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 20A9077 CA Primary

Addresses

Primary practice location

1014 San Juan Ave.
Exeter, CA 93221

Mailing address

400 W Mineral King Ave
Visalia, CA 93291-6237
Phone (559) 624-2000

Other identifiers 1

IdentifierTypeStateIssuer
1629029194MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160322000546 CA Practitioner - Obstetrics/Gynecology 8426055849

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2611 N Dinuba Blvd
Visalia, CA 93291-9003

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A9077CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Healthcare Network Past Accepting new patients
Major Hospital Past Accepting new patients
Family Healthcare Network Past Accepting new patients
Family Healthcare Network Past Accepting new patients
Kaweah Delta Health Care District Past Accepting new patients
Kaweah Delta Health Care District Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1629029194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W MINERAL KING AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916237",
            "telephone_number": "559-624-2000",
            "fax_number": "559-732-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 SAN JUAN AVE.",
            "city": "EXETER",
            "state": "CA",
            "postal_code": "93221",
            "telephone_number": "559-592-7300",
            "fax_number": "559-624-6590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHADEMI",
        "first_name": "TALAKSOON",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "20A9077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629029194",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Exeter, CA

Sources for this page

Verify at the official NPI Registry.