Provider Demographics
NPI:1376674689
Name:KHAJA R AHMED MD
Entity type:Organization
Organization Name:KHAJA R AHMED MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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:2007-03-08
Last Update Date:2008-08-12
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
CA00A454231Medicaid
CAF00744Medicare UPIN
CA00A454231Medicaid