Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 21707 | WV |
N | 208600000X | Surgeon | 21707 | WV |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | N0286 | TX |
NPI | 1154300903 |
---|---|
Provider Name | Mr. Khaja Moinuddeen |
First Address | Sugar Land, TX 77479-5320 |
Second Address | Sugar Land, TX 77479-5320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 28/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
299860102 | (05) | TX |
3810001306 | (05) | WV |