Provider Demographics
NPI:1275505562
Name:KHASIGIAN, HARRY ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:ALFRED
Last Name:KHASIGIAN
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 1:7551 TIMBERLAKE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5422
Mailing Address - Country:US
Mailing Address - Phone:916-525-0620
Mailing Address - Fax:916-525-0639
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-525-0620
Practice Address - Fax:916-525-0639
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29772207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G297720Medicaid
CA00G297720Medicare ID - Type Unspecified
CA00G297720Medicaid