Provider Demographics
NPI:1720499536
Name:KHOY, DINNA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DINNA
Middle Name:
Last Name:KHOY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SAVAGE ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2802
Mailing Address - Country:US
Mailing Address - Phone:617-320-9002
Mailing Address - Fax:
Practice Address - Street 1:1261 FURNACE BROOK PKWY STE 31
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4768
Practice Address - Country:US
Practice Address - Phone:818-122-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308771363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1720499536Medicaid