Provider Demographics
NPI:1124498571
Name:YAZDANNEJAD, KHATOUN
Entity type:Individual
Prefix:
First Name:KHATOUN
Middle Name:
Last Name:YAZDANNEJAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAHNAZ
Other - Middle Name:
Other - Last Name:YAZDANNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9950 DURANT DR UNIT 402
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1610
Mailing Address - Country:US
Mailing Address - Phone:310-866-8450
Mailing Address - Fax:
Practice Address - Street 1:3828 DELMAS TER
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2713
Practice Address - Country:US
Practice Address - Phone:310-836-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590162163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult