Healthcare Provider Details

I. General information

NPI: 1275487084
Provider Name (Legal Business Name): KHALED ABUMANSOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 IBN SUROUR, ASH SHATI DIST.
JEDDAH MECCA
23414
SA

IV. Provider business mailing address

3432 IBN SUROUR, ASH SHATI DIST.
JEDDAH MECCA
23414
SA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: