Healthcare Provider Details

I. General information

NPI: 1497673438
Provider Name (Legal Business Name): KHALED AHMED DAHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW JEFFERSON ST # 632
BLUE SPRINGS MO
64015-7263
US

IV. Provider business mailing address

3300 NW JEFFERSON ST # 632
BLUE SPRINGS MO
64015-7263
US

V. Phone/Fax

Practice location:
  • Phone: 816-503-0641
  • Fax:
Mailing address:
  • Phone: 816-503-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number024069
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: