# KSK NURSING CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497503130
- **Authorized official:** KHADEER KHAN DNP, MSN, FNP, PMHNP (DIRECTOR)
- **Authorized official phone:** (310) 387-2054

## Contact information

- **Practice address:** 1875 W REDONDO BEACH BLVD STE 308, GARDENA, CA 90247-3644
- **Practice address phone:** (310) 387-2054
- **Mailing address:** 506 PHELAN LN, REDONDO BEACH, CA 90278-5309
- **Mailing address phone:** (310) 387-2054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/08/2024
- **Last updated:** 11/27/2024