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General NPI Number Information
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NPI Number | 1255488821
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Entity Type | Individual
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Provider Name | DEANNA YADAO KHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 E BEVERLY BLVD 404
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City | MONTEBELLO
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State | CA
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Zip | 90640-4300
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Country | US
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Telephone | 323-722-6861
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Fax | 323-722-0158
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Provider Business Mailing Address
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Address Line | 8707 COLIMA RD
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City | WHITTIER
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State | CA
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Zip | 90605-1309
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Country | US
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Telephone | 310-696-6251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | A30976
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License Number State | CA
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