Healthcare Provider Details

I. General information

NPI: 1871639682
Provider Name (Legal Business Name): HENRY HTWELAY KHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 N MOUNTAIN AVE STE A
UPLAND CA
91786-4372
US

IV. Provider business mailing address

2331 EL CAPITAN AVE
ARCADIA CA
91006
US

V. Phone/Fax

Practice location:
  • Phone: 909-579-2555
  • Fax: 909-579-2118
Mailing address:
  • Phone: 626-574-7102
  • Fax: 626-574-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA064156
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA64156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: