Provider Demographics
NPI:1255478715
Name:KHANKHANIAN, MOEIZ (MD)
Entity Type:Individual
Prefix:
First Name:MOEIZ
Middle Name:
Last Name:KHANKHANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 S SUNSET AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3410
Mailing Address - Country:US
Mailing Address - Phone:626-813-1222
Mailing Address - Fax:626-813-1221
Practice Address - Street 1:933 S SUNSET AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3410
Practice Address - Country:US
Practice Address - Phone:626-813-1222
Practice Address - Fax:626-813-1221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA411342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41134Medicare ID - Type Unspecified