Provider Demographics
NPI:1679570527
Name:KHWAJA, SHAMSUDDIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMSUDDIN
Middle Name:
Last Name:KHWAJA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 AMBASSADOR ST
Mailing Address - Street 2:APT. 111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2858
Mailing Address - Country:US
Mailing Address - Phone:310-551-2772
Mailing Address - Fax:310-551-2891
Practice Address - Street 1:1201 E HERNDON AVE
Practice Address - Street 2:VALLEY CARDIAC SURGERY, SUITE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3238
Practice Address - Country:US
Practice Address - Phone:559-435-3740
Practice Address - Fax:559-261-9073
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA85907208G00000X
TXL3718208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)