Provider Demographics
NPI:1508825381
Name:SIAL, KHURAM A (M D)
Entity Type:Individual
Prefix:
First Name:KHURAM
Middle Name:A
Last Name:SIAL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3098
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-734-7246
Practice Address - Fax:877-694-3331
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA904212081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90421OtherSTATE LICENSE
CABS8877156/XS8877156OtherDEA
CAA90421OtherSTATE LICENSE
CA00A904211Medicare PIN