Provider Demographics
NPI:1053587451
Name:ANEES, KHALED ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:ADAM
Last Name:ANEES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12195 WYNE CT
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1185
Mailing Address - Country:US
Mailing Address - Phone:949-333-9000
Mailing Address - Fax:
Practice Address - Street 1:13217 JAMBOREE RD STE 301
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-9158
Practice Address - Country:US
Practice Address - Phone:949-333-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011116742084N0400X
WI62835-202084N0400X
IL0361527182084N0400X
CODR.00592632084N0400X
NJ25MA099543002084N0400X
CAA1186452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology