Provider Demographics
NPI:1528689429
Name:KAHHALEH, MOMEN KHALED (MD)
Entity type:Individual
Prefix:
First Name:MOMEN
Middle Name:KHALED
Last Name:KAHHALEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 CHERRY STREET
Mailing Address - Street 2:ACC BASEMENT, ATTN CATHY NELSON-AUTDENCAMP
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608
Mailing Address - Country:US
Mailing Address - Phone:419-251-9429
Mailing Address - Fax:419-251-6849
Practice Address - Street 1:2213 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:419-251-8019
Practice Address - Fax:419-251-0370
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2022-05-11
Deactivation Date:2022-04-15
Deactivation Code:
Reactivation Date:2022-05-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program