Provider Demographics
NPI:1003608845
Name:KHAIREH, UBAH
Entity type:Individual
Prefix:
First Name:UBAH
Middle Name:
Last Name:KHAIREH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 TESSMAN PKWY N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445
Mailing Address - Country:US
Mailing Address - Phone:763-269-9996
Mailing Address - Fax:
Practice Address - Street 1:9012 TESSMAN PKWY N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445
Practice Address - Country:US
Practice Address - Phone:763-269-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN420918376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator