Provider Demographics
NPI:1205662509
Name:KHOUNDA, MALACK M
Entity type:Individual
Prefix:
First Name:MALACK
Middle Name:M
Last Name:KHOUNDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 E GERARD AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-9073
Mailing Address - Country:US
Mailing Address - Phone:209-261-5650
Mailing Address - Fax:
Practice Address - Street 1:1766 E GERARD AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-9073
Practice Address - Country:US
Practice Address - Phone:209-261-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider