Amjad Al-Khawaldeh, PHD, CNS, NP
Individual provider Active NPI Nurse Practitioner · Laguna Hills, CA
NPI 1477091445 · NPPES record last updated Jun 1, 2026
Key facts
- NPI
- 1477091445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 95006131 (CA)
- Practice address
- 24953 Paseo de Valencia Ste 24a
Laguna Hills, CA 92653-4343 - Phone
- (714) 875-3755
- NPI assigned
- Feb 9, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.07 of 100
- Quality
- 82.43
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 65.06
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210409000761 | CA | Practitioner - Nurse Practitioner | 9133537269 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Specialist, Nurse Practitioner, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95006131 | CA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| UC Regents | Current | Accepting new patients | |
| UC Regents | Current |
Accepting new patients | |
| Shifa Regenerative Center and Pain Management | Current |
Accepting new patients | |
| UC Regents | Current |
Accepting new patients |
Locations
17150 Euclid St
Ste 207
Fountain Valley, CA 92708
Phone (714) 542-3439
24953 Paseo de Valencia
Ste 24A
Laguna Hills, CA 92653
Phone (714) 875-3755
101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95006131 | CA | Yes |
Addresses
Primary practice location
24953 Paseo de Valencia Ste 24a
Laguna Hills, CA 92653-4343
Mailing address
2012 Fallen Leaf PL
Tustin, CA 92780-6713
Phone (714) 875-3755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95006131 | Other | CA | NP LICENSE AND FURNISHING NUMBER |
Other providers in Laguna Hills, CA
- Akuwell LLC
- Al Manesh DMD Inc
- Al-Abdulla DDS Inc
- Angham Al-Abdulla
- Rachelle Al-Kazzi
- Dalia Al-Mudallal
- Aladino Razo Psychiatric PC
- Nili N. Alai
- Gamiel Alamares
- Christina Alba
All providers in Laguna Hills, CA · Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.