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NPI Code Detail

MEDICARE: KINGS HEALTHCARE CLINICS LLC

MEDICARE: KINGS HEALTHCARE CLINICS LLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1700525813
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINGS HEALTHCARE CLINICS LLC
Provider Business Mailing Address
First Line : 21175 TOMBALL PKWY STE 504
Second Line :
City : HOUSTON
State : TX
Zip : 77070-1655
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3102 LINWOOD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4231
Country : US
Telephone Number : 318-749-2476
Fax Number :
Authorized Official
Title or Position : OWNER
Name : AHMED SHUJA
Credential :
Telephone Number : 469-257-3500
Provider Enumeration Date : 05/27/2022
Last Update Date : 06/03/2022

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Directions to “KINGS HEALTHCARE CLINICS LLC ” Practice Location

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