Provider Demographics
NPI:1467544742
Name:KHALDOUN S. SROUJIEH, MD, INC
Entity Type:Organization
Organization Name:KHALDOUN S. SROUJIEH, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALDOUN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SROUJIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-664-6535
Mailing Address - Street 1:1300 NORTH VERMONT AVENUE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-664-6535
Mailing Address - Fax:323-664-2964
Practice Address - Street 1:1300 NORTH VERMONT AVENUE
Practice Address - Street 2:SUITE 401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-664-6535
Practice Address - Fax:323-664-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A335080Medicaid
CA00A335080Medicaid
CAD71917Medicare UPIN