Khadeer Khan, MSN, DNP, FNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

19864 Issued in CA

Practice address

1875 W Redondo Beach Blvd Ste 308
Gardena, CA 90247-3644

Phone

(310) 387-2054

Fax

(310) 362-3598

NPI assigned

Oct 26, 2010

Last updated

Nov 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science - Nursing, Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ehab Yacoub MD Inc.

  dba Brain Health USA

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713

  Single Specialty

  Medicare reassignment NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Single Specialty

  Medicare reassignment NPD
• Mission City Community Network, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hollywood, CA
  • NPI 1710102009

  Single Specialty

  Medicare reassignment NPD
• KSK Nursing Corporation

  • Psychiatric/Mental Health Nurse Practitioner
  • Gardena, CA
  • NPI 1497503130
  Authorized official Same address or phone
• Mission City Community Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Victorville, CA
  • NPI 1265708994

  Single Specialty

  NPD
• Mission City Community Network, Inc.

  • Community Health Clinic/Center
  • North Hills, CA
  • NPI 1710370747

  Single Specialty

  NPD
• Gail Levee, M.D.

  • Family Medicine Physician
  • Redondo Beach, CA
  • NPI 1285906669

  Single Specialty

  NPD (past)
• Sutter Bay Hospitals

  dba Alta Bates Summit Medical Center - Summit Campus

  • Rehabilitation Hospital Unit
  • Oakland, CA
  • NPI 1194171371
  NPD (past)

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

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1588964456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 PHELAN LN",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902785309",
            "telephone_number": "310-387-2054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 W REDONDO BEACH BLVD STE 308",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473644",
            "telephone_number": "310-387-2054",
            "fax_number": "310-362-3598"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 N Prairie Ave Ste 311",
            "address_purpose": "LOCATION",
            "city": "Inglewood",
            "state": "CA",
            "postal_code": "903014510",
            "country_code": "US",
            "telephone_number": "818-895-3100",
            "fax_number": "310-981-4064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "KHADEER",
        "credential": "MSN, DNP, FNP, PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-26",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "19864",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "19864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195UT0EB",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christa Timil Jafre Keyes-Venson
• Nidal Khaja, D.P.M.
• Anna Marie Khaldi
• Mena Khalil
• Manoutcher Khalili, MD
• Melba K Khan, NONE
• Salar Khorramnezhad
• Sara Joelle Khoury
• Kigawa Chiropractic, Inc. (Chie Kigawa D.C.)
• Chie Kigawa, D.C.

• Psychiatric/Mental Health Nurse Practitioner in Gardena, CA
• Providers in Gardena, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.