Provider Demographics
NPI:1205519030
Name:AL-HOURANI, KHALID
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:
Last Name:AL-HOURANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TRAVELER STREET
Mailing Address - Street 2:UNIT 1304
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-638-8934
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF ORTHOPEDIC SURGERY
Practice Address - Street 2:85 E CONCORD STREET 4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3013872390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program