# KHEMARA FAMILY MEDICAL CLINIC INC.

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

## Provider details

- **NPI number:** 1508296146
- **Authorized official:** DR. NAGASAMUDRA S. ASHOK M.D. (SOLE PROPRIETOR)
- **Authorized official phone:** (562) 439-3803

## Contact information

- **Practice address:** 440 REDONDO AVE STE 201, LONG BEACH, CA 90814-5145
- **Practice address phone:** (562) 439-3803
- **Practice address fax:** (866) 593-7781
- **Mailing address:** 440 REDONDO AVE STE 201, LONG BEACH, CA 90814-5145
- **Mailing address phone:** (562) 439-3803
- **Mailing address fax:** (866) 593-7781

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A41589 | CA | Yes |

## Other

- **Enumeration date:** 11/18/2013
- **Last updated:** 12/17/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 10940873 | CAQA PROVIDER ENROLLMENT | CA |
| 01 | — | A41589 | MEDICAL LICENSE | CA |
| 01 | — | ZZZ58486Y | BLUE SHIELD PROVIDER \# | CA |