1801194006 NPI number — KHAJA R AHMED M.D. A PROFESSIONAL CORPORATION

Table of content: (NPI 1801194006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801194006 NPI number — KHAJA R AHMED M.D. A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHAJA R AHMED M.D. A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KHAJA R. AHMED M.D.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801194006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20911 EARL ST
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90503-4352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-370-4660
Provider Business Mailing Address Fax Number:
310-793-0710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20911 EARL ST
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90503-4352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-370-4660
Provider Business Practice Location Address Fax Number:
310-793-0710
Provider Enumeration Date:
03/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
KHAJA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-370-4660

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  A45423 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A45423 . This is a "CA STATE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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