Provider Demographics
NPI:1154608974
Name:KHAJA MOINUDDEEN,MD,PA
Entity type:Organization
Organization Name:KHAJA MOINUDDEEN,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOINUDDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-706-1500
Mailing Address - Street 1:20403 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4976
Mailing Address - Country:US
Mailing Address - Phone:832-886-4525
Mailing Address - Fax:832-886-4418
Practice Address - Street 1:20403 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4976
Practice Address - Country:US
Practice Address - Phone:832-886-4525
Practice Address - Fax:832-886-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0286208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty