Provider Demographics
NPI:1225302789
Name:SHERIF KHAMIS MD INC
Entity Type:Organization
Organization Name:SHERIF KHAMIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIF
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-347-0065
Mailing Address - Street 1:7257 OWENSMOUTH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1530
Mailing Address - Country:US
Mailing Address - Phone:818-347-0065
Mailing Address - Fax:818-587-3687
Practice Address - Street 1:7257 OWENSMOUTH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1530
Practice Address - Country:US
Practice Address - Phone:818-347-0065
Practice Address - Fax:818-587-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A433740Medicaid