Provider Demographics
NPI:1558329623
Name:HAMEED, KHAN JAVED (MD)
Entity Type:Individual
Prefix:MR
First Name:KHAN
Middle Name:JAVED
Last Name:HAMEED
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 1:1135 S SUNSET AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3937
Mailing Address - Country:US
Mailing Address - Phone:626-337-3500
Mailing Address - Fax:626-338-8044
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-337-3500
Practice Address - Fax:626-338-8044
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA376642086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A376640Medicaid
CA00A376640Medicaid