Provider Demographics
NPI:1285186015
Name:ALIUDDIN KHAJA, MD., INC
Entity Type:Organization
Organization Name:ALIUDDIN KHAJA, MD., INC
Other - Org Name:STANFORD PSYCHIATRY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-952-3517
Mailing Address - Street 1:854 MAGNOLIA AVE,
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:CORONNA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:951-356-5414
Mailing Address - Fax:
Practice Address - Street 1:1300 W FLORIDA AVE
Practice Address - Street 2:SUITE - C
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4612
Practice Address - Country:US
Practice Address - Phone:805-952-3517
Practice Address - Fax:951-356-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty