Healthcare Provider Details

I. General information

NPI: 1518172519
Provider Name (Legal Business Name): FARIDEH KHOINY F.N.P, APRN, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE STE 814
LONG BEACH CA
90813-3424
US

IV. Provider business mailing address

5631 E ANAHEIM RD
LONG BEACH CA
90815-4402
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-9637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number253713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: