Provider Demographics
NPI:1992885883
Name:MEHDIKHAN, MINOO (PHD)
Entity type:Individual
Prefix:MS
First Name:MINOO
Middle Name:
Last Name:MEHDIKHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 LUCHESSI DR SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:408-445-7552
Mailing Address - Fax:408-445-7553
Practice Address - Street 1:1131 LUCHESSI DR SUITE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118
Practice Address - Country:US
Practice Address - Phone:408-445-7552
Practice Address - Fax:408-445-7553
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist