Provider Demographics
NPI:1710559877
Name:JABI, KHALDOUN (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALDOUN
Middle Name:
Last Name:JABI
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 1:1392 E BARTLETT WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3132
Mailing Address - Country:US
Mailing Address - Phone:216-456-7741
Mailing Address - Fax:
Practice Address - Street 1:3920 S ALMA SCHOOL RD STE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4511
Practice Address - Country:US
Practice Address - Phone:216-456-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery