Individual
KULSUMA KHANOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6176 NEWTOWN AVE, PHILADELPHIA, PA 19111-5928
(267) 250-1630
Mailing address
6176 NEWTOWN AVE, PHILADELPHIA, PA 19111-5928
(267) 250-1630
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27804551
DL
PA
Enumeration date
05/28/2020
Last updated
05/28/2020
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