Provider Demographics
NPI:1114686227
Name:KHAJA ZAKI MD LLC
Entity Type:Organization
Organization Name:KHAJA ZAKI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-809-3404
Mailing Address - Street 1:2410 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:727-499-0351
Mailing Address - Fax:727-781-3312
Practice Address - Street 1:5041 WESTSHORE DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3043
Practice Address - Country:US
Practice Address - Phone:727-809-3404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068556900Medicaid