Provider Demographics
NPI:1932168796
Name:DEBIAN, KHALDOUN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALDOUN
Middle Name:A
Last Name:DEBIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 IRVINE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3030
Mailing Address - Country:US
Mailing Address - Phone:714-937-9400
Mailing Address - Fax:714-937-9404
Practice Address - Street 1:17400 IRVINE BLVD STE F
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3030
Practice Address - Country:US
Practice Address - Phone:714-937-9400
Practice Address - Fax:714-937-9404
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63521207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG11559Medicare UPIN
CAA63521Medicare ID - Type UnspecifiedMEDICARE