Provider Demographics
NPI:1427006113
Name:HAMEED A. KHAN, M.D., INC.
Entity Type:Organization
Organization Name:HAMEED A. KHAN, M.D., INC.
Other - Org Name:SOUTH TORRANCE MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMEED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN MD INC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-5464
Mailing Address - Street 1:3655 LOMITA BLVD
Mailing Address - Street 2:SUITE 421
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3931
Mailing Address - Country:US
Mailing Address - Phone:310-540-5464
Mailing Address - Fax:310-540-4761
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:SUITE 421
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3931
Practice Address - Country:US
Practice Address - Phone:310-540-5464
Practice Address - Fax:310-540-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31453174400000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314530Medicaid
CAW2731OtherM/CARE GROUP #
CAWA31453AMedicare ID - Type UnspecifiedM/CARE PROVIDER #
CAW2731OtherM/CARE GROUP #