Provider Demographics
NPI:1255488821
Name:KHAN, DEANNA YADAO (MD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:YADAO
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8707 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1309
Mailing Address - Country:US
Mailing Address - Phone:310-696-6251
Mailing Address - Fax:
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:404
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-722-6861
Practice Address - Fax:323-722-0158
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30976302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization