Provider Demographics
NPI:1871639682
Name:KHIN, HENRY HTWELAY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:HTWELAY
Last Name:KHIN
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 1:2331 EL CAPITAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-574-7102
Mailing Address - Fax:626-574-3970
Practice Address - Street 1:732 N MOUNTAIN AVE STE A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4372
Practice Address - Country:US
Practice Address - Phone:909-579-2555
Practice Address - Fax:909-579-2118
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0641562084P0800X
CAA641562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641560Medicaid
CAA64156Medicare ID - Type UnspecifiedMEDICARE
CAH32342Medicare UPIN