Provider Demographics
NPI:1215091632
Name:KHANIJOU, ANJU (MD)
Entity type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:KHANIJOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W LA VETA AVE STE 210A
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4446
Mailing Address - Country:US
Mailing Address - Phone:714-744-9717
Mailing Address - Fax:714-744-0635
Practice Address - Street 1:725 W LA VETA AVE STE 210A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4446
Practice Address - Country:US
Practice Address - Phone:714-744-9717
Practice Address - Fax:714-744-0635
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0344612080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF90737Medicare UPIN