Abdallah Khourdaji, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

00A341430 Issued in CA

Practice address

801 S Ham LN
Ste a
Lodi, CA 95242-7501

Phone

(209) 333-6110

Fax

(209) 333-0724

NPI assigned

Dec 6, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Other, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Golden State Dermatology Associates, Inc.Group PAC ID 1052418175, 118 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Lodi Memorial Hospital, Lodi, CA, CCN 050336

Merit-based Incentive Payment System (MIPS)

Final score

99.15 of 100Reported as group

Promoting interoperability

99

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Golden State Dermatology Associates, Inc.

  • Dermatology Physician
  • Walnut Creek, CA
  • NPI 1700860871
  Medicare reassignment Care Compare group NPD
• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804
  Medicare reassignment
• Golden State Dermatology Associates, Inc.

  • Ambulatory Surgical Clinic/Center
  • Fresno, CA
  • NPI 1235738576
  NPD
• California Pacific Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Oakland, CA
  • NPI 1275002453
  NPD (past)
• Dameron Hospital Association

  • General Acute Care Hospital
  • Stockton, CA
  • NPI 1538163886
  NPD (past)
• Lodi Memorial Hospital Association Inc

  • Rehabilitation Hospital Unit
  • Lodi, CA
  • NPI 1821028671
  NPD (past)
• Port City Operating Company, LLC

  • General Acute Care Hospital
  • Stockton, CA
  • NPI 1528190931
  NPD (past)
• Sutter North Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lodi Memorial Hospital Association Inc

  • General Acute Care Hospital
  • Lodi, CA
  • NPI 1316938301
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281484800000",
    "number": "1093799652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S HAM LN",
            "address_2": "STE A",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952427501",
            "telephone_number": "209-333-6110",
            "fax_number": "209-333-0724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S HAM LN",
            "address_2": "STE A",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952427501",
            "telephone_number": "209-333-6110",
            "fax_number": "209-333-0724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOURDAJI",
        "first_name": "ABDALLAH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2010-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "00A341430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070001716",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrina Begum Khan I
• Shakila B. Khan
• Zaman Khan, PHARM.D
• Zershana Khan, MD
• Nauman Khattak
• Ayad Khourdaji, M.D.
• Sophany Khuth
• Valerie J. Kidd, M.D.
• Kids Therapy 4 Success
• Garrett Thomas Kieffer, DPT

• Dermatology Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.