Healthcare Provider Details

I. General information

NPI: 1316706070
Provider Name (Legal Business Name): MOHAMED HATEM KHALAF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1104
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 714-592-5549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number341113
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: