Healthcare Provider Details

I. General information

NPI: 1447849575
Provider Name (Legal Business Name): KSJ MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST CAPITOL DR
SAINT CHARLES MO
63301-2844
US

IV. Provider business mailing address

23 TODDINGTON TER
SAINT LOUIS MO
63128-2632
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5000
  • Fax: 636-333-4510
Mailing address:
  • Phone: 201-407-3489
  • Fax: 636-333-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: KHALED JUMEAN
Title or Position: OWNER
Credential: MD
Phone: 201-407-3489