Provider Demographics
NPI:1609958180
Name:KHAN-HUDSON, ALIA (MD)
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:
Last Name:KHAN-HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-436-4444
Mailing Address - Fax:714-436-4812
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:GRECC (11G) VAGLAHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4842
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA89051207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI49733Medicare UPIN