| Khalil Foundation | |
|
3033 Scott Blvd Santa Clara CA 95054-3316 | |
| (630) 474-4414 | |
| (630) 230-3364 |
| Full Name | Khalil Foundation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3033 Scott Blvd, Santa Clara, California |
| Authorized Official Name and Position | Hooman Keshavarzi (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2246223116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Khalil Foundation 999 N Main St Suite 103 Glen Ellyn IL 60137-3581 Ph: (630) 474-4414 | Khalil Foundation 3033 Scott Blvd Santa Clara CA 95054-3316 Ph: (630) 474-4414 |
| NPI Number | 1407225709 |
|---|---|
| Provider Enumeration Date | 09/17/2015 |
| Last Update Date | 10/07/2015 |
| Medicare PECOS PAC ID | 4284056466 |
|---|---|
| Medicare Enrollment ID | O20200616002420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407225709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 77379 (California) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A115077 (California) | Primary |
| Provider Name | Dilek M Mccombs |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982948063 PECOS PAC ID: 9830343854 Enrollment ID: I20130129000050 |
| Provider Name | Mohamad Ata |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457698169 PECOS PAC ID: 0143583484 Enrollment ID: I20180418002634 |
| Provider Name | Fahad Habib Khan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649514266 PECOS PAC ID: 5193147379 Enrollment ID: I20200616002619 |
| Provider Name | Mariam F Aboukar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013448620 PECOS PAC ID: 1456623404 Enrollment ID: I20200616003027 |
| Provider Name | Samar Harfi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538497441 PECOS PAC ID: 1759794704 Enrollment ID: I20210112000644 |
| Provider Name | Syed Yusuf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427547546 PECOS PAC ID: 5092042168 Enrollment ID: I20210616000293 |
| Provider Name | Abdulaziz Syed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326582073 PECOS PAC ID: 0143608554 Enrollment ID: I20220525001905 |
| Provider Name | Rama Atieh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174257893 PECOS PAC ID: 3274917554 Enrollment ID: I20220906001793 |
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