Provider Demographics
NPI:1336310093
Name:ABOUELHOSN, KHALDOUN (MD)
Entity Type:Individual
Prefix:
First Name:KHALDOUN
Middle Name:
Last Name:ABOUELHOSN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALDOUN
Other - Middle Name:
Other - Last Name:ABOULHOSN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:332 S JUNIPER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4941
Mailing Address - Country:US
Mailing Address - Phone:866-228-2236
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:2185 CITRACADO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4159
Practice Address - Country:US
Practice Address - Phone:866-228-2236
Practice Address - Fax:760-737-3430
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA108970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD337Medicare PIN