Provider Demographics
NPI:1750578654
Name:KHANI, NIAZ (PSYD)
Entity type:Individual
Prefix:DR
First Name:NIAZ
Middle Name:
Last Name:KHANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2335
Mailing Address - Country:US
Mailing Address - Phone:323-744-0608
Mailing Address - Fax:310-264-0676
Practice Address - Street 1:3201 WILSHIRE BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2335
Practice Address - Country:US
Practice Address - Phone:323-744-0608
Practice Address - Fax:310-264-0676
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical