Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4286 | CA |
Y | 222Z00000X | Podiatrist | E4286 | CA |
NPI | 1033266390 |
---|---|
Provider Name | Dr. Marjorie J Khawam |
First Address | Long Beach, CA 90808-2146 |
Second Address | Long Beach, CA 90808-2146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 09/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E42860 | (05) | CA |
480034704 | RAILROAD MEDICARE (01) | CA |
U81170 | (02) |