Provider Demographics
NPI:1801437520
Name:KHAJADOUR DONABEDIAN DDS INC
Entity type:Organization
Organization Name:KHAJADOUR DONABEDIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KHAJADOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:DONABEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-449-1919
Mailing Address - Street 1:2063 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3277
Mailing Address - Country:US
Mailing Address - Phone:626-449-1919
Mailing Address - Fax:626-449-8775
Practice Address - Street 1:2063 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3277
Practice Address - Country:US
Practice Address - Phone:626-449-1919
Practice Address - Fax:626-449-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental