Provider Demographics
NPI:1427220417
Name:KHIJNIAK, ANNA ILINICHNA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:ILINICHNA
Last Name:KHIJNIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:ILINICHNA
Other - Last Name:DAVIDOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 WEST CARSON STREET
Mailing Address - Street 2:BLDG 1 SOUTH
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502
Mailing Address - Country:US
Mailing Address - Phone:424-306-5853
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2059
Practice Address - Country:US
Practice Address - Phone:424-306-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1140162084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
07142037OtherECFMG ID #
CAA114016OtherCALI THE MEDICAL BOARD OF CALIFORNIA
CAA114016OtherCALI THE MEDICAL BOARD OF CALIFORNIA