MEDICARE: LEEA KHAIOIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95037696	CA

General Provider Information

NPI Number	:	1164380358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEEA KHAIOIAN

Provider Business Mailing Address
First Line	:	1319 ALLEN AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 ALLEN AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1105
Country	:	US
Telephone Number	:	818-414-4456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ LEEA KHAIOIAN ” Practice Location

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