Provider Demographics
NPI:1588195424
Name:AL-KHAYYAT, MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AL-KHAYYAT
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 1:9655 MONTE VISTA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2238
Mailing Address - Country:US
Mailing Address - Phone:909-626-1205
Mailing Address - Fax:909-670-0473
Practice Address - Street 1:9635 MONTE VISTA AVE STE 205
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2235
Practice Address - Country:US
Practice Address - Phone:909-621-0009
Practice Address - Fax:909-399-9265
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA166446208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist