Healthcare Provider Details

I. General information

NPI: 1124476270
Provider Name (Legal Business Name): WASEEM MAJED KHADER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 BROADWAY
EL CAJON CA
92021-4994
US

IV. Provider business mailing address

1240 BROADWAY
EL CAJON CA
92021-4994
US

V. Phone/Fax

Practice location:
  • Phone: 619-841-1310
  • Fax: 619-841-1311
Mailing address:
  • Phone: 619-841-1310
  • Fax: 619-841-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A16567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16567
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number20A16567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: