Provider Demographics
NPI:1861719221
Name:KHALIGHI, KATAYOUN (MD)
Entity type:Individual
Prefix:
First Name:KATAYOUN
Middle Name:
Last Name:KHALIGHI
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 1:2140 GRAND AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6800
Mailing Address - Country:US
Mailing Address - Phone:909-630-7875
Mailing Address - Fax:909-630-7876
Practice Address - Street 1:2140 GRAND AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6800
Practice Address - Country:US
Practice Address - Phone:909-630-7875
Practice Address - Fax:909-630-7876
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FK1866548OtherDEA