Provider Demographics
NPI:1457915969
Name:ZAKI, KHALED MOHAB (NP)
Entity Type:Individual
Prefix:MR
First Name:KHALED
Middle Name:MOHAB
Last Name:ZAKI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1227 SUNNY CT APT 22
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2841
Mailing Address - Country:US
Mailing Address - Phone:425-772-6320
Mailing Address - Fax:
Practice Address - Street 1:13847 E 14TH ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2626
Practice Address - Country:US
Practice Address - Phone:510-924-7667
Practice Address - Fax:510-878-7345
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95137678390200000X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program