Provider Demographics
NPI:1487671368
Name:FAREED, KHALED (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:
Last Name:FAREED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KHALED
Other - Middle Name:FARID
Other - Last Name:ABDEL-AZIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11100 WARNER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7511
Mailing Address - Country:US
Mailing Address - Phone:714-546-1121
Mailing Address - Fax:714-546-0428
Practice Address - Street 1:11100 WARNER AVE STE 206
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7511
Practice Address - Country:US
Practice Address - Phone:714-546-1121
Practice Address - Fax:714-546-0428
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC169178208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC169178Medicaid