Healthcare Provider Details

I. General information

NPI: 1710779525
Provider Name (Legal Business Name): MRS. DARYA KHOUDOIAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ROSE DR
YORBA LINDA CA
92886-2026
US

IV. Provider business mailing address

5542 E VISTA DEL DIA
ANAHEIM CA
92807-3844
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-6680
  • Fax:
Mailing address:
  • Phone: 818-317-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number783215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: