Provider Demographics
NPI:1518153733
Name:ABID HAMEED KHAN MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ABID HAMEED KHAN MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABID
Authorized Official - Middle Name:HAMEED
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-984-0313
Mailing Address - Street 1:2229 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1397
Mailing Address - Country:US
Mailing Address - Phone:909-984-0313
Mailing Address - Fax:909-984-0319
Practice Address - Street 1:1001 W. SIXTH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:909-984-0313
Practice Address - Fax:909-984-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A528060Medicare PIN