Provider Demographics
NPI:1265465066
Name:KHAMO, SARGON (MA)
Entity Type:Individual
Prefix:MR
First Name:SARGON
Middle Name:
Last Name:KHAMO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 LONDON LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2235
Mailing Address - Country:US
Mailing Address - Phone:847-544-6181
Mailing Address - Fax:
Practice Address - Street 1:8118 N MILWAUKEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2836
Practice Address - Country:US
Practice Address - Phone:847-696-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001080237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter