Provider Demographics
NPI:1033210497
Name:KHOSA, RUPDEV S (MD)
Entity Type:Individual
Prefix:
First Name:RUPDEV
Middle Name:S
Last Name:KHOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W DUARTE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7360
Mailing Address - Country:US
Mailing Address - Phone:626-445-7500
Mailing Address - Fax:626-445-7555
Practice Address - Street 1:550 W DUARTE RD STE 4
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7360
Practice Address - Country:US
Practice Address - Phone:626-445-7500
Practice Address - Fax:626-445-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54411208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A4544110OtherBC/BS
CA00A544110Medicaid
CA250011214OtherRAILROAD
CAG94748Medicare UPIN
CA250011214OtherRAILROAD