Provider Demographics
NPI:1659772622
Name:KHAZAI, MOHAMMAD HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HASSAN
Last Name:KHAZAI
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 1:100 LINCOLN RD
Mailing Address - Street 2:UNIT 1221
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2013
Mailing Address - Country:US
Mailing Address - Phone:310-701-5408
Mailing Address - Fax:
Practice Address - Street 1:100 LINCOLN RD
Practice Address - Street 2:UNIT 1221
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2013
Practice Address - Country:US
Practice Address - Phone:310-701-5408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 120423207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine