=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346044773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOIEZ KHANKHANIAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2025
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 SALISBURY RD
-----------------------------------------------------
City | LA CANADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-515-4514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 SALISBURY RD
-----------------------------------------------------
City | LA CANADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-515-4514
-----------------------------------------------------
Fax | 888-235-1709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOIEZ KHANKHANIAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-515-4519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------