Provider Demographics
NPI:1023696390
Name:KHAA LLC
Entity type:Organization
Organization Name:KHAA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAEIMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:TABARANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-629-6686
Mailing Address - Street 1:19465 DEERFIELD AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1702
Mailing Address - Country:US
Mailing Address - Phone:703-629-6089
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE STE 107
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1702
Practice Address - Country:US
Practice Address - Phone:703-629-6089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy