Provider Demographics
NPI:1528609591
Name:KHEIR, MINA FAWZY MAGDY
Entity type:Individual
Prefix:
First Name:MINA FAWZY
Middle Name:MAGDY
Last Name:KHEIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W 38TH ST APT 10H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1195
Mailing Address - Country:US
Mailing Address - Phone:917-915-2090
Mailing Address - Fax:
Practice Address - Street 1:325 KENT AVE APT 325
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-5296
Practice Address - Country:US
Practice Address - Phone:917-915-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06151101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty