MEDICARE: NAMIR KATKHOUDA MD

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	208600000X	Surgery Physician	A54640	CA

General Provider Information

NPI Number	:	1164450714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAMIR KATKHOUDA MD

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-442-9062
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 SAN PABLO ST
Second Line	:	SUITE 6200
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-4500
Country	:	US
Telephone Number	:	323-442-9062
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	11/27/2023

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