Healthcare Provider Details

I. General information

NPI: 1255488821
Provider Name (Legal Business Name): DEANNA YADAO KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BEVERLY BLVD 404
MONTEBELLO CA
90640-4300
US

IV. Provider business mailing address

8707 COLIMA RD
WHITTIER CA
90605-1309
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-6861
  • Fax: 323-722-0158
Mailing address:
  • Phone: 310-696-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberA30976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: