Provider Demographics
NPI:1982003620
Name:KHAYAT, LENNA GHOSHEH
Entity Type:Individual
Prefix:
First Name:LENNA
Middle Name:GHOSHEH
Last Name:KHAYAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6050
Mailing Address - Country:US
Mailing Address - Phone:650-455-7979
Mailing Address - Fax:
Practice Address - Street 1:2028 OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6050
Practice Address - Country:US
Practice Address - Phone:650-455-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist