Provider Demographics
NPI:1841435062
Name:DONABEDIAN, KHAJADOUR (DDS)
Entity type:Individual
Prefix:
First Name:KHAJADOUR
Middle Name:
Last Name:DONABEDIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice