Provider Demographics
NPI:1730402645
Name:KANSAS KIDS HEART CENTER, PA
Entity type:Organization
Organization Name:KANSAS KIDS HEART CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:AL-AHDAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-440-8800
Mailing Address - Street 1:7015 E. CENTRAL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1946
Mailing Address - Country:US
Mailing Address - Phone:316-440-8800
Mailing Address - Fax:316-440-8802
Practice Address - Street 1:7015 E. CENTRAL
Practice Address - Street 2:SUITE 2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1946
Practice Address - Country:US
Practice Address - Phone:316-440-8800
Practice Address - Fax:316-440-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44567363LP0200X
KS04-320742080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1033133576OtherNPI
KS1336172014OtherNPI