Provider Demographics
NPI:1427220417
Name:KHIJNIAK, ANNA ILINICHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:ILINICHNA
Last Name:KHIJNIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:ILINICHNA
Other - Last Name:DAVIDOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2600 REDONDO AVE, 6TH FLOOR
Mailing Address - Street 2:LONG BEACH CHILD AND ADOLESCENT PROGRAM
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90506
Mailing Address - Country:US
Mailing Address - Phone:562-256-2906
Mailing Address - Fax:
Practice Address - Street 1:2600 REDONDA AVE, 6TH FLOOR
Practice Address - Street 2:LA COUNTY DMH, LONG BEACH CHILD AND ADOLESCENT PROGRAM
Practice Address - City:LOING BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-256-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1140162084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
07142037OtherECFMG ID #
CAA114016OtherCALI THE MEDICAL BOARD OF CALIFORNIA
CAA114016OtherCALI THE MEDICAL BOARD OF CALIFORNIA