Healthcare Provider Details

I. General information

NPI: 1457468902
Provider Name (Legal Business Name): WENDY ANN KHENTIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SAXONY ROAD SUITE 201
ENCINITAS CA
92024
US

IV. Provider business mailing address

345 SAXONY ROAD SUITE 201
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-753-7341
  • Fax: 760-753-6403
Mailing address:
  • Phone: 760-753-7341
  • Fax: 760-753-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG072521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: