Provider Demographics
NPI:1225271125
Name:KHAN, SADIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SADIA
Middle Name:S
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4959 PALO VERDE ST
Mailing Address - Street 2:SUITE 204 A
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2331
Mailing Address - Country:US
Mailing Address - Phone:909-398-0497
Mailing Address - Fax:909-398-0499
Practice Address - Street 1:4959 PALO VERDE ST
Practice Address - Street 2:SUITE 204 A
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2331
Practice Address - Country:US
Practice Address - Phone:909-398-0497
Practice Address - Fax:909-398-0499
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine