Provider Demographics
NPI:1679649743
Name:KHALIFE, MOHAMMED WALID (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:WALID
Last Name:KHALIFE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60790
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116-6790
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:1350 W COVINA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3245
Practice Address - Country:US
Practice Address - Phone:909-599-6811
Practice Address - Fax:909-394-3367
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA31097207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEH524ZMedicare PIN
A26351Medicare UPIN