Provider Demographics
NPI:1477754612
Name:KHAJA, ALIUDDIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALIUDDIN
Middle Name:M
Last Name:KHAJA
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 1:770 MAGNOLIA AVE STE 2F
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3122
Mailing Address - Country:US
Mailing Address - Phone:805-952-3517
Mailing Address - Fax:
Practice Address - Street 1:770 MAGNOLIA AVE STE 2F
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3122
Practice Address - Country:US
Practice Address - Phone:805-952-3517
Practice Address - Fax:951-356-5494
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA921862084P0805X, 2084S0012X
CAA 921862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine