Basic Information
| Provider Information | |||||||||
| NPI: | 1336119601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAW | ||||||||
| FirstName: | KENNETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE. | ||||||||
| Address2: | BLDG 200, STE 211 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096777776 | ||||||||
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| Practice Location | |||||||||
| Address1: | 219 NORTH WHITE HORSE PIKE | ||||||||
| Address2: | STE 109 | ||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095735077 | ||||||||
| FaxNumber: | 6096528258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA05373800 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 25MA05373800 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 6103006 | 05 | NJ | MEDICAID |