Provider Demographics
NPI:1275610552
Name:KHANJAN, MARJAN KALHORI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:KALHORI
Last Name:KHANJAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28041 MARTINIQUE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5269
Mailing Address - Country:US
Mailing Address - Phone:949-295-2318
Mailing Address - Fax:
Practice Address - Street 1:17401 IRVINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3028
Practice Address - Country:US
Practice Address - Phone:949-365-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30001103TC0700X
CA30001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical