Healthcare Provider Details

I. General information

NPI: 1710980974
Provider Name (Legal Business Name): KHURRAM MOIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W OAK ST
KISSIMMEE FL
34741-4421
US

IV. Provider business mailing address

311 W OAK ST
KISSIMMEE FL
34741-4421
US

V. Phone/Fax

Practice location:
  • Phone: 407-933-1423
  • Fax: 407-933-7901
Mailing address:
  • Phone: 407-933-1423
  • Fax: 407-933-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME77258
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME77258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: