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General NPI Number Information
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NPI Number | 1174869515
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Entity Type | Individual
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Provider Name | MOHAMED KHALED MSD
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Gender | Male
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 140 N A ST
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City | OXNARD
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State | CA
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Zip | 93030-5315
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Country | US
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Telephone | 818-312-4530
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Fax |
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Provider Business Mailing Address
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Address Line | 26500 AGOURA RD STE 102-468
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City | CALABASAS
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State | CA
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Zip | 91302-1952
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Country | US
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Telephone | 818-312-4530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2901020820
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 63881
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 39369
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License Number State | TX
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