Provider Demographics
NPI:1487670485
Name:KHAN, MOHD. QAISAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHD. QAISAR
Middle Name:A
Last Name:KHAN
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 1:1535 W MERCED AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3404
Mailing Address - Country:US
Mailing Address - Phone:626-918-4566
Mailing Address - Fax:626-851-9254
Practice Address - Street 1:1535 W MERCED AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3404
Practice Address - Country:US
Practice Address - Phone:626-918-4566
Practice Address - Fax:626-851-9254
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313220Medicaid
CAA87544Medicare UPIN
CA00A313220Medicaid