Healthcare Provider Details

I. General information

NPI: 1346044773
Provider Name (Legal Business Name): MOIEZ KHANKHANIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 08/19/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SALISBURY RD
LA CANADA CA
91011
US

IV. Provider business mailing address

815 SALISBURY RD
LA CANADA CA
91011
US

V. Phone/Fax

Practice location:
  • Phone: 818-515-4514
  • Fax:
Mailing address:
  • Phone: 818-515-4514
  • Fax: 888-235-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MOIEZ KHANKHANIAN
Title or Position: OWNER
Credential: M.D.
Phone: 818-515-4519