Provider Demographics
NPI:1174869515
Name:KHALED, MOHAMED (MSD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:KHALED
Suffix:
Gender:M
Credentials:MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26500 AGOURA RD
Mailing Address - Street 2:STE 102-468
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1952
Mailing Address - Country:US
Mailing Address - Phone:818-312-4530
Mailing Address - Fax:
Practice Address - Street 1:140 N A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5315
Practice Address - Country:US
Practice Address - Phone:818-312-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010208201223P0300X
CA638811223P0300X
TX393691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXXXXOtherXXX