Healthcare Provider Details

I. General information

NPI: 1366949828
Provider Name (Legal Business Name): DENA KHAEF PANAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 06/27/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

2114 WILDFLOWER CIR
BREA CA
92821-4437
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-0455
  • Fax:
Mailing address:
  • Phone: 310-733-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: