Provider Demographics
NPI:1730121484
Name:KHURAM AKBAR SIAL, M.D., PC
Entity Type:Organization
Organization Name:KHURAM AKBAR SIAL, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHURAM
Authorized Official - Middle Name:AKBAR
Authorized Official - Last Name:SIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-240-1418
Mailing Address - Street 1:25568 VIA SARAH
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7405
Mailing Address - Country:US
Mailing Address - Phone:951-240-1418
Mailing Address - Fax:
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-734-7246
Practice Address - Fax:951-734-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90421OtherSTATE LICENSE
CAZZZ30944ZOtherMEDICARE
CAZZZ30944ZOtherMEDICARE