Provider Demographics
NPI:1700168382
Name:JASON Y KHAMLY, M.D. INC
Entity Type:Organization
Organization Name:JASON Y KHAMLY, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:YOUN-ECK
Authorized Official - Last Name:KHAMLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-533-7357
Mailing Address - Street 1:1314 S EUCLID STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1314 S EUCLID STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2079
Practice Address - Country:US
Practice Address - Phone:714-533-7357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty