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General NPI Number Information
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NPI Number | 1427385681
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Entity Type | Organization
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Legal Business Name | KHC GROUP PC
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 45 THOMAS JOHNSON DR
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City | FREDERICK
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State | MD
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Zip | 21702-4425
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Country | US
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Telephone | 301-637-3350
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Fax | 301-576-5221
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Provider Business Mailing Address
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Address Line | 5419 HOLLYWOOD BLVD C751
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City | LOS ANGELES
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State | CA
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Zip | 90027-3480
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Country | US
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Telephone | 301-637-3350
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Fax | 301-576-5221
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Authorized Official
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Title or Position | PRESIDENT
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Name | BILAL R KAAKI
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Credential | M.D.
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Telephone | 301-637-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 21D1034190
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License Number State | MD
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