Provider Demographics
NPI:1588236236
Name:KHOURY, JEANINE CHAFIK FARID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:CHAFIK FARID
Last Name:KHOURY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N ORANGE ST UNIT 216
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-5503
Mailing Address - Country:US
Mailing Address - Phone:818-512-8142
Mailing Address - Fax:
Practice Address - Street 1:321 N ORANGE ST UNIT 216
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-5503
Practice Address - Country:US
Practice Address - Phone:818-512-8142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist