Provider Demographics
NPI:1154504900
Name:KHAN, HASHIM ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:HASHIM
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HASHIM
Other - Middle Name:ALI
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3131 BERGER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4203
Mailing Address - Country:US
Mailing Address - Phone:858-244-6800
Mailing Address - Fax:858-244-6809
Practice Address - Street 1:3131 BERGER AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4203
Practice Address - Country:US
Practice Address - Phone:858-244-6800
Practice Address - Fax:858-244-6809
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110977207RI0011X, 207RI0011X
TXQ5203207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154504900Medicaid
IL036122673Medicaid
IL90998005OtherMEDICARE PTAN