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NPI Code Detail

MEDICARE: DR. NIDAL KHAJA D.P.M.

MEDICARE: DR. NIDAL KHAJA D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristEL1636CA
2213ES0103XFoot & Ankle Surgery PodiatristE4807CA

General Provider Information

NPI Number : 1013177633
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NIDAL KHAJA D.P.M.
Provider Business Mailing Address
First Line : 955 DEEP VALLEY DR
Second Line : # 4055
City : PALOS VERDES PENINSULA
State : CA
Zip : 90274-3876
Country : US
Telephone Number : 310-538-1110
Fax Number : 310-538-0929
Provider Business Practice Location Address
First Line : 1246 W 155TH ST
Second Line :
City : GARDENA
State : CA
Zip : 90247-4011
Country : US
Telephone Number : 310-768-2256
Fax Number : 310-323-0914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2008
Last Update Date : 10/21/2021

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