Healthcare Provider Details

I. General information

NPI: 1225302789
Provider Name (Legal Business Name): SHERIF KHAMIS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 OWENSMOUTH AVE SUITE A
CANOGA PARK CA
91303-1530
US

IV. Provider business mailing address

7257 OWENSMOUTH AVE SUITE A
CANOGA PARK CA
91303-1530
US

V. Phone/Fax

Practice location:
  • Phone: 818-347-0065
  • Fax: 818-587-3687
Mailing address:
  • Phone: 818-347-0065
  • Fax: 818-587-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43374
License Number StateCA

VIII. Authorized Official

Name: DR. SHERIF KHAMIS
Title or Position: CEO
Credential:
Phone: 818-347-0065