Provider Demographics
NPI:1972554160
Name:KHWAJA, SAMIA A (MD)
Entity type:Individual
Prefix:
First Name:SAMIA
Middle Name:A
Last Name:KHWAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 MARTIN LUTHER KING JR BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3512
Mailing Address - Country:US
Mailing Address - Phone:323-725-0051
Mailing Address - Fax:323-869-9245
Practice Address - Street 1:3621 MARTIN LUTHER KING JR BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3512
Practice Address - Country:US
Practice Address - Phone:323-725-0051
Practice Address - Fax:323-869-9245
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30635207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067120Medicaid
CAA87428Medicare UPIN
CAW13623Medicare ID - Type Unspecified