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General NPI Number Information
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NPI Number | 1376049528
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Entity Type | Individual
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Provider Name | MAEDEH KHAYYAT KHOLGHI DO
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 18700 N 64TH DR STE 301
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City | GLENDALE
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State | AZ
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Zip | 85308-7114
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Country | US
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Telephone | 602-841-0741
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3098
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Country | US
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Telephone | 503-494-8211
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 011221
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NM
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