Provider Demographics
NPI:1801194006
Name:KHAJA R AHMED M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KHAJA R AHMED M.D. A PROFESSIONAL CORPORATION
Other - Org Name:KHAJA R. AHMED M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-370-4660
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-370-4660
Mailing Address - Fax:310-793-0710
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 180
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-370-4660
Practice Address - Fax:310-793-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45423207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45423OtherCA STATE
CAA45423OtherCA STATE