MEDICARE: HIRA KHALID

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1659969277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIRA KHALID

Provider Business Mailing Address
First Line	:	7157 ALVERN STREET
Second Line	:	G212
City	:	LOS ANGELES
State	:	CA
Zip	:	90045
Country	:	US
Telephone Number	:	949-266-4406
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4265
Country	:	US
Telephone Number	:	323-294-4932
Fax Number	:

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

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	01/08/2021

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Directions to “ HIRA KHALID ” Practice Location

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