Provider Demographics
NPI:1467476598
Name:KHAMIS, SHERIF ZAKI (MD)
Entity Type:Individual
Prefix:
First Name:SHERIF
Middle Name:ZAKI
Last Name:KHAMIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 WINNETKA AVE
Mailing Address - Street 2:SUITE # 14
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3646
Mailing Address - Country:US
Mailing Address - Phone:818-347-0065
Mailing Address - Fax:818-587-3687
Practice Address - Street 1:7111 WINNETKA AVE
Practice Address - Street 2:SUITE # 14
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-3646
Practice Address - Country:US
Practice Address - Phone:818-347-0065
Practice Address - Fax:818-587-3687
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A433740Medicaid
CA010723640OtherCORPORATION