Provider Demographics
NPI:1548214570
Name:SIDDIQUE, KHAWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KHAWAR
Middle Name:
Last Name:SIDDIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-746-5918
Mailing Address - Fax:323-433-7016
Practice Address - Street 1:8436 W 3RD ST
Practice Address - Street 2:SUITE 800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4163
Practice Address - Country:US
Practice Address - Phone:310-746-5918
Practice Address - Fax:323-433-7016
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85394207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA85394BMedicare PIN
CAI23832Medicare UPIN
WA85394CMedicare PIN