Provider Demographics
NPI:1659683217
Name:PEDIATRIC ADULT ENDOCRINE GILBERT
Entity Type:Organization
Organization Name:PEDIATRIC ADULT ENDOCRINE GILBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:SYED
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-253-4420
Mailing Address - Street 1:25078 PEACHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2558
Mailing Address - Country:US
Mailing Address - Phone:661-253-4420
Mailing Address - Fax:661-253-4425
Practice Address - Street 1:25078 PEACHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2558
Practice Address - Country:US
Practice Address - Phone:661-253-4420
Practice Address - Fax:661-253-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC134457207RE0101X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ147208Medicaid
AZF79584Medicare UPIN
AZZ150843Medicare PIN