Provider Demographics
NPI:1033843362
Name:KHUN, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:KHUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1007
Mailing Address - Country:US
Mailing Address - Phone:978-397-3035
Mailing Address - Fax:
Practice Address - Street 1:1668 S GARFIELD AVE FL 2
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5400
Practice Address - Country:US
Practice Address - Phone:626-943-6476
Practice Address - Fax:626-900-9558
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program