Provider Demographics
NPI:1033137633
Name:AHMED, KHAJA R (MD)
Entity Type:Individual
Prefix:MR
First Name:KHAJA
Middle Name:R
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-370-4660
Mailing Address - Fax:310-793-0710
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 180
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-370-4660
Practice Address - Fax:310-793-0710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45423207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454231Medicaid
CA00A454231Medicaid
CAA45423Medicare ID - Type Unspecified