Provider Demographics
NPI:1316951197
Name:DAEE, JALEH KHORSHA (MD)
Entity type:Individual
Prefix:
First Name:JALEH
Middle Name:KHORSHA
Last Name:DAEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9470 ANNAPOLIS RD
Mailing Address - Street 2:#418
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:301-459-8108
Mailing Address - Fax:301-459-6694
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:#418
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-459-8108
Practice Address - Fax:301-459-6694
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0032761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B94395Medicare UPIN
MD196841Medicare ID - Type Unspecified