Provider Demographics
NPI:1902916711
Name:TAWANSY, KHALED ALY (MD)
Entity Type:Individual
Prefix:MR
First Name:KHALED
Middle Name:ALY
Last Name:TAWANSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 N FIGUEROA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1718
Mailing Address - Country:US
Mailing Address - Phone:323-257-3937
Mailing Address - Fax:323-257-3200
Practice Address - Street 1:7447 N FIGUEROA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1718
Practice Address - Country:US
Practice Address - Phone:323-257-3937
Practice Address - Fax:323-257-3200
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76762207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G767620Medicaid
CAWG76762BMedicare UPIN