Healthcare Provider Details

I. General information

NPI: 1801437520
Provider Name (Legal Business Name): KHAJADOUR DONABEDIAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2063 E FOOTHILL BLVD
PASADENA CA
91107-3277
US

IV. Provider business mailing address

2063 E FOOTHILL BLVD
PASADENA CA
91107-3277
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-1919
  • Fax: 626-449-8775
Mailing address:
  • Phone: 626-449-1919
  • Fax: 626-449-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KHAJADOUR DONABEDIAN
Title or Position: DENTIST
Credential: DDS
Phone: 626-449-1919