MEDICARE: DR. MARJORIE J KHAWAM DPM

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
1	213E00000X	Podiatrist	E4286	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480034704	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033266390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARJORIE J KHAWAM DPM

Provider Business Mailing Address
First Line	:	3816 WOODRUFF AVE
Second Line	:	STE 302
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2146
Country	:	US
Telephone Number	:	562-429-5300
Fax Number	:	562-429-0535

Provider Business Practice Location Address
First Line	:	3816 WOODRUFF AVE
Second Line	:	STE 302
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2146
Country	:	US
Telephone Number	:	562-429-5300
Fax Number	:	562-429-0535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	04/09/2009

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