Healthcare Provider Details

I. General information

NPI: 1154300903
Provider Name (Legal Business Name): KHAJA MOINUDDEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 01/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 SANDHILL DR
SUGAR LAND TX
77479-5320
US

IV. Provider business mailing address

4911 SANDHILL DR
SUGAR LAND TX
77479-5320
US

V. Phone/Fax

Practice location:
  • Phone: 281-238-7870
  • Fax: 281-633-4985
Mailing address:
  • Phone: 281-238-7870
  • Fax: 281-633-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21707
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberN0286
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: