Healthcare Provider Details

I. General information

NPI: 1548240369
Provider Name (Legal Business Name): KHALED JOUJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 GLEN HILL RD
LOUISVILLE KY
40222-6026
US

IV. Provider business mailing address

PO BOX 221646
LOUISVILLE KY
40252-1646
US

V. Phone/Fax

Practice location:
  • Phone: 270-298-4889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29680
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number29680
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: