Provider Demographics
NPI:1417919085
Name:HASAN, KHALID S (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:S
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SY
Other - Middle Name:
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25078 PEACHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2558
Mailing Address - Country:US
Mailing Address - Phone:661-253-4420
Mailing Address - Fax:661-253-4425
Practice Address - Street 1:25078 PEACHLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:480-821-2883
Practice Address - Fax:480-237-5799
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC134457207RE0101X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ147208Medicaid
AZ147208Medicaid
AZZ150843Medicare PIN