Provider Demographics
NPI:1477645380
Name:KHALDOUN A DEBIAN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KHALDOUN A DEBIAN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KHALDOUN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-937-9400
Mailing Address - Street 1:17400 IRVINE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3030
Mailing Address - Country:US
Mailing Address - Phone:714-937-9400
Mailing Address - Fax:714-937-9404
Practice Address - Street 1:17400 IRVINE BLVD STE F
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3030
Practice Address - Country:US
Practice Address - Phone:147-937-9400
Practice Address - Fax:714-937-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63521207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty