Provider Demographics
NPI:1033205463
Name:BS KHEHAR MD INC
Entity Type:Organization
Organization Name:BS KHEHAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHUPHINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHEHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-291-9285
Mailing Address - Street 1:4060 FOURTH AVE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2116
Mailing Address - Country:US
Mailing Address - Phone:619-291-9285
Mailing Address - Fax:619-291-9289
Practice Address - Street 1:4060 FOURTH AVE
Practice Address - Street 2:SUITE 335
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-291-9285
Practice Address - Fax:619-291-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19010OtherINTERNAL MEDICINE
CA00A618910Medicaid
CA00A618910OtherBLUE SHIELD
G80928Medicare UPIN
W19010Medicare PIN
W19010Medicare PIN