Provider Demographics
NPI:1326289737
Name:SADEEQ KHAN SADIQ, INC.
Entity Type:Organization
Organization Name:SADEEQ KHAN SADIQ, INC.
Other - Org Name:CORONADO BAY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SADEEQ
Authorized Official - Middle Name:KHAN
Authorized Official - Last Name:SADIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-423-0100
Mailing Address - Street 1:888 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-1529
Mailing Address - Country:US
Mailing Address - Phone:619-423-0100
Mailing Address - Fax:619-423-0120
Practice Address - Street 1:888 PALM AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-1529
Practice Address - Country:US
Practice Address - Phone:619-423-0100
Practice Address - Fax:619-423-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89200261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care