Provider Demographics
NPI:1124476270
Name:KHADER, WASEEM MAJED (DO)
Entity type:Individual
Prefix:DR
First Name:WASEEM
Middle Name:MAJED
Last Name:KHADER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4994
Mailing Address - Country:US
Mailing Address - Phone:619-841-1310
Mailing Address - Fax:619-841-1311
Practice Address - Street 1:1240 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4994
Practice Address - Country:US
Practice Address - Phone:619-841-1310
Practice Address - Fax:619-841-1311
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16567207QA0401X, 207Q00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty