Provider Demographics
NPI:1558310185
Name:KHATTAB, SHERIF M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:M
Last Name:KHATTAB
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 1:23365 HAWTHORNE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3720
Mailing Address - Country:US
Mailing Address - Phone:310-325-2100
Mailing Address - Fax:310-325-7400
Practice Address - Street 1:23365 HAWTHORNE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3720
Practice Address - Country:US
Practice Address - Phone:310-325-2100
Practice Address - Fax:310-325-7400
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE01639Medicare UPIN