MEDICARE: MR. KAMOL KHODJAEV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171R00000X	Interpreter

General Provider Information

NPI Number	:	1871381210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAMOL KHODJAEV

Provider Business Mailing Address
First Line	:	5001 SEMINARY RD APT 1314
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1919
Country	:	US
Telephone Number	:	202-510-4187
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 SEMINARY RD APT 1314
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1919
Country	:	US
Telephone Number	:	202-510-4187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2025
Last Update Date	:	06/18/2025

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